Free Medicines for Solidarity Supplement Recipients Now Stop at the Reference Price: What Changes at the Pharmacy From 17 October

From today, 17 October, the free medicines received by people on the Complemento Solidário para Idosos (CSI, the Solidarity Supplement for Older People) come with a condition. Where a cheaper equivalent exists, the state now pays only up to the reference price for that group of medicines, and a beneficiary who chooses a dearer brand pays the difference.

The rule is set by Decreto-Lei n.º 169/2026, published in the Diário da República (the official gazette) on 18 August and in force 60 days after publication. We reported the decree when it was published; this is what it means now that it applies.

What has changed

Since 2024, under Decreto-Lei n.º 37/2024, CSI recipients have had 100 percent of the part of a prescription medicine's price not covered by the state paid for them. The new decree keeps the 100 percent but changes what it is calculated on:

• Medicines in a "homogeneous group". A grupo homogéneo is a set of medicines with the same active substance, dose and route of administration, in the same or an equivalent form, that includes at least one generic on the market (Portaria n.º 195-B/2015). For these, the extra payment is capped at 100 percent of the group's reference price, or at the medicine's retail price where that is lower.
• Medicines with no homogeneous group, or prescribed with the doctor's technical justification that they cannot be substituted: the state still pays 100 percent of the retail price.

The government's preamble cites waste and "less efficient" consumption choices found by monitoring, and says it wants wider use of generic and biosimilar medicines.

What to do at the counter

Pharmacies already have duties under the medicines law, Decreto-Lei n.º 176/2006, article 120.º-A. When dispensing, the pharmacist must tell you which medicines they have with the same active substance, form, presentation and dose as the one prescribed, which are subsidised by the SNS (the national health service) and which has the lowest price on the market. Pharmacies must keep at least three of the five cheapest in each group in stock, and must dispense the cheapest unless you choose otherwise.

The new decree adds a safeguard for CSI recipients. If a pharmacy breaks those duties to supply or to inform, it must immediately supply the equivalent medicine you chose, and you cannot be charged anything extra for it.

In practice: ask for the cheapest equivalent to pay nothing, and if you prefer a particular brand, ask the price first.

What stays the same

There is nothing to apply for. The Instituto da Segurança Social (Social Security Institute) says in its practical guide to the additional health benefits that CSI recipients are entitled automatically, and that the medicines benefit applies when you show a prescription at the pharmacy. That guide dates from January and does not yet mention the reference-price cap. According to gov.pt, people who have only just applied for the CSI get free medicines after their first CSI payment.

The decree does not change the other two benefits:

• 75 percent of the cost of glasses and lenses, up to 100 euros every two years;
• 75 percent of the cost of removable dentures, up to 250 euros every three years.

These are refunds, not discounts. Take the prescription and the receipt to the health centre where you are registered within six months of the purchase; the first time, also bring the Social Security declaration confirming that you receive the CSI. Who qualifies for the supplement itself is covered in our guide to claiming the CSI.