Portugal Limits Free Medicines for Low-Income Pensioners to Generic and Reference Prices From October

Portugal has quietly rewritten one of the more generous benefits available to its poorest older residents. A decree published in the official gazette on 18 August 2026 changes how the state pays for medicines for the more than 220,000 elderly people who receive them free through the Complemento Solidário para Idosos (CSI, the Solidarity Supplement for the Elderly) — tying that free access to generic medicines and reference prices from October.

The medicines do not stop being free. But the definition of "free" is being narrowed, and for anyone attached to a particular brand-name drug, the change could mean paying a difference that until now the state covered in full.

What the decree does

Decreto-Lei n.º 169/2026, of 18 August — published in the Diário da República (the official gazette), Series I, No. 159 — is the third amendment to the 2007 law that created a set of "additional health benefits" for CSI recipients. Its single substantive change concerns medication reimbursement, and it works like this:

• For a medicine that belongs to a homogeneous group — meaning there are interchangeable equivalents, typically including generics — the state's full reimbursement is capped at 100% of the group's reference price (the preço de referência), or at the medicine's own retail price where that is lower.
• For a medicine that is not in a homogeneous group — where there is no interchangeable equivalent — the state still pays 100% of that medicine's retail price.

In plain terms: where a cheaper equivalent exists, the state will fund the medicine up to the price of the cheaper option. A beneficiary who chooses a more expensive brand within that group would cover the gap themselves. Where no equivalent exists, nothing changes — the medicine remains fully paid.

This is a step back from the position set in 2024, when a previous decree made these medicines 100% free outright (before that, the benefit had covered 50%). The government's stated aim, set out in the decree's preamble, is to steer beneficiaries toward generic and lower-cost medicines while, in its words, "maintaining the guarantee that medicines are free." The 2024 full-cost period, it argues, exposed "inefficiencies" — including waste and "less efficient consumption choices" — that the new cap is meant to correct.

Who is affected

The CSI is a means-tested top-up for pensioners on very low incomes, and the additional health benefits ride on top of it. According to the Ministry of Labour, Solidarity and Social Security (MTSSS), more than 220,000 elderly people received free medicines through the scheme in 2026. The programme has grown fast: the total number of CSI beneficiaries has risen roughly 75% since 2024, reaching around 245,500 by June 2026. Our guide to stacking the CSI on top of a low pension sets out who qualifies and how the supplement is calculated.

The change matters to some low-income foreign pensioners too, since the CSI is open to legal residents who meet the income and residence conditions. For anyone in that position, the practical advice is simple and unchanged from good pharmacy practice generally: ask for the generic. Where a generic or reference-priced option exists, it remains completely free; the cost only appears if a pricier alternative within the same group is chosen.

What is not changing

It is worth being precise, because the CSI health package covers more than medicines. The same scheme also reimburses 75% of the cost of glasses and lenses (up to €100 every two years) and 75% of removable dental prostheses (up to €250 every three years). Those benefits are untouched by this decree — only the medication rule is being changed. Anyone reading that the CSI health benefits have been "cut" should understand the change is confined to how brand-name medicines within a substitutable group are funded.

When it takes effect

The decree enters into force 60 days after publication, which puts the new rule in place around 17 October 2026. It was approved by the Council of Ministers in April, promulgated by President António José Seguro on 7 August, and signed by the Prime Minister, the Health Minister and the Labour and Social Security Minister.

The move sits alongside a wider tightening of how medicine subsidies are policed in Portugal — a theme we covered when diabetes specialists warned that an out-of-date health-registry record could cost patients their reimbursements. For the day-to-day mechanics of collecting a prescription, from the paperless receita sem papel codes to reimbursement at the counter, see our guide to how pharmacies work in Portugal. Readers who rely on the wider net of low-income supports may also want our guide to the Prestação Social para a Inclusão.