Patients Paid 571 Million Euros at Portuguese Pharmacy Counters in Seven Months, While the State's Share Climbed Four Times Faster
INFARMED's July report puts patient spending at 571.6 million euros, up 2.1 percent, and the SNS share at 1,179.3 million, up 8.3 percent. The average co-payment per pack actually fell two cents. What rose was volume, and one diabetes class accounts for a third of the increase.
Between January and July this year, people in Portugal paid 571.6 million euros of their own money at pharmacy counters for prescription medicines. Over the same seven months the state paid 1,179.3 million euros towards the same prescriptions. Both numbers went up. They did not go up at anything like the same speed.
The figures come from the monthly ambulatory medicines spending report published by INFARMED, the national medicines authority, in its July edition. The patient share rose by 11.7 million euros on the same period of 2025, an increase of 2.1 percent. The state's share rose by 89.9 million euros, an increase of 8.3 percent. For every extra euro patients handed over, the Serviço Nacional de Saúde (SNS, National Health Service) handed over almost eight.
The average patient is paying slightly less per box
The detail that gets lost in the headline total is that individual co-payments did not rise at all. The average amount a patient pays per pack was 4.70 euros between January and July 2026, two cents lower than the 4.72 euros of a year earlier. The equivalent figure for the SNS was 9.70 euros per pack, up 52 cents, and more than double what the patient pays.
What went up was volume. Pharmacies dispensed 121.6 million packs in the seven months, roughly 3 million more than in the same stretch of 2025, a rise of 2.5 percent. Prescribing rose faster still: 225.9 million units prescribed, up 5 percent, against SNS consultations that were essentially flat at 20.8 million, up 0.6 percent. More medicine is being written per appointment, and the total bill is following the volume rather than the price of an individual box.
That combination is why the patient total can climb while the individual patient experience barely changes. It also explains something that has been a recurring complaint in Portugal, where households carry a high share of medicine costs relative to income: the burden is being spread across more transactions rather than being made heavier per transaction.
One therapeutic class, a third of the increase
The concentration in the data is striking. Antidiabetics cost the SNS 305.5 million euros in the seven months, 25.9 percent of the entire ambulatory medicines bill, and rose 31.4 million euros year on year. That single class accounts for 34.9 percent of the total increase in state spending.
Inside it, one substance does most of the work. Semaglutide, the active ingredient marketed for type 2 diabetes and also widely used for weight loss, cost the SNS 42.4 million euros between January and July. That is almost 15 million euros more than a year earlier, a rise of 54.6 percent, and it accounts for 16.6 percent of the entire year-on-year increase in the state's ambulatory medicines bill. No other substance comes close as a driver, although apixaban, an anticoagulant, is second at 13.5 million euros of additional cost, a rise of 39.2 percent.
The rest of the top ten by spending is a portrait of an ageing population on long-term prescriptions: dapagliflozin at 63.5 million euros, apixaban at 48.0 million, dapagliflozin with metformin at 44.4 million, empagliflozin at 35.0 million, sacubitril with valsartan at 31.5 million. Renin angiotensin modifiers, anticoagulants and lipid-lowering drugs follow antidiabetics as the classes with the largest bills.
The generics share is going the wrong way
More than half the units dispensed were still generics, at 50.5 percent of the total market. But that share has fallen 0.7 percentage points year on year, and it is now well below the 52.2 percent reached in 2024. In the competitive market segment, where a generic alternative exists, the generic share fell 1.3 points to 63.1 percent. In homogeneous groups, the narrower comparison the pricing system uses, it slipped 0.2 points to 66.6 percent.
The average cost per pack across the whole market, meanwhile, rose 37 cents against 2025, to 14.40 euros. Brand-name medicines averaged 19.28 euros a pack and generics 8.61 euros. A drifting generics share and a rising average pack cost point the same way: the growth is in newer, patented, more expensive molecules that have no generic competitor yet.
What the figures do not include
INFARMED attaches a caution to the report that matters for anyone reading the 1,179.3 million euro figure as the state's final cost. The numbers do not reflect the contributions arising from the agreement between the government and the Associação Portuguesa da Indústria Farmacêutica (Portuguese Pharmaceutical Industry Association), nor those from financing contracts. In practice, industry contributions and rebates to the SNS will be deducted from the headline total later. The gross figure is what the report publishes; the net figure is lower and is not in it.
The patient side carries no such asterisk. The 571.6 million euros is money that changed hands at the counter. For readers on low incomes, the rules on what the state covers change at the start of next month: Portugal restricted free medicines for low-income pensioners to generic and reference prices from October, which means the choice between a branded pack and its generic equivalent now decides whether a prescription is free or not.
