Alzheimer Portugal Presses the State to Fund the New Drugs That Slow the Disease

A new generation of Alzheimer’s drugs has reached Portugal — but only for those who can pay for it out of their own pocket. The patient association Alzheimer Portugal is now pressing the state to change that, calling for the treatments to be reimbursed (comparticipados) by the National Health Service (Serviço Nacional de Saúde, SNS) so that access no longer depends on a family’s bank balance.

The drugs at the heart of the campaign are lecanemab, sold as Leqembi, and donanemab, marketed as Kisunla. Both are monoclonal antibodies that target the build-up of amyloid protein in the brain, and both have been authorised for use in the European Union after positive opinions from the European Medicines Agency (EMA). Crucially, they do not cure Alzheimer’s: in clinical trials they modestly slowed the decline of patients in the early stages of the disease, buying time rather than reversing damage. That distinction has divided the medical community over how much they are really worth.

What is not in dispute is the cost. A course of donanemab, given by monthly infusion over around 18 months, has been reported to run to roughly €40,000 — a sum currently borne entirely by the patient, because the SNS does not yet reimburse either drug. In practice, that means access in Portugal today is limited to those who can either travel abroad for treatment or obtain a special authorisation from the national medicines regulator, INFARMED, the National Authority of Medicines and Health Products (Autoridade Nacional do Medicamento e Produtos de Saúde).

INFARMED is the body that will ultimately decide. It is carrying out a pharmacoeconomic evaluation — weighing the clinical benefit of the drugs against their price — that will determine whether they are financed by the public system and on what terms. Reimbursement decisions of this kind routinely take months and often end with conditions attached, such as restricting a drug to the specific patient groups who stand to benefit most.

The eligibility rules are already narrow. The EMA cleared lecanemab only for patients in the earliest stages of Alzheimer’s who carry one or no copies of a gene variant known as ApoE4, after evidence that people with two copies faced a higher risk of dangerous brain swelling and bleeding. That means even if reimbursement is granted, the treatments would reach a relatively small, carefully screened group rather than the wider population of people living with dementia.

Patient advocates argue there is a second bottleneck beyond price. They point to a roughly six-month stretch in which INFARMED approved no new Early Access Programmes (Programas de Acesso Precoce, PAP) — the mechanism that lets seriously ill patients reach innovative medicines before full reimbursement is settled. For a degenerative disease in which every month of delay can mean irreversible loss, they say, procedural gaps are not abstract: they translate directly into lost windows of opportunity for individual patients.

For the many residents in Portugal caring for an ageing parent or partner, the debate is more than academic. Dementia is one of the fastest-growing health burdens across Europe, and the arrival of the first drugs that can measurably alter its course has raised hopes that collide with hard questions of cost, evidence and fairness. Whether Portugal chooses to fund them — and for whom — will be one of the more consequential health decisions of the year, set against a health service already stretched by summer staffing pressures.