Portuguese Pay the Highest Share of Income on Medicines Among Peer Nations

Portugal ranks last among its benchmark countries for equity in access to medicines, according to the first edition of the Medicines Access Equity Index released on Wednesday by the Portuguese Association of Medicines for Equity in Health (EQUALMED).

The study, covering the period from 2022 to 2025, found that Portugal scores a moderate 52% on equity of access — meaning roughly five out of every ten Portuguese residents can be said to have genuinely equitable access to the medication they need. That figure trails Spain, Italy, France, and Belgium, the countries Portugal uses as reference points for its drug pricing policies.

The financial burden on individuals is particularly stark. Each Portuguese citizen spends an average of 148.30 euros per year on medication, against an average annual salary of 20,451 euros. In France, the country with the lowest out-of-pocket drug costs among the group, average spending is just 72.70 euros per year, set against a salary of 44,904 euros. The result: Portuguese workers devote a significantly larger share of their earnings to staying healthy.

The consequences extend beyond household budgets. Based on statistical correlations, the study estimates that Portugal experiences roughly four fewer years of quality of life per capita than France, and calculates that 1,577 deaths from treatable conditions could have been prevented during the study period had Portugal achieved French levels of access equity. A 5% improvement in equity, the researchers suggest, could be associated with a 3% annual reduction in treatable mortality.

Adding to the problem, a separate finding from the Observador reported that approximately one-third of medicines authorised in Portugal never actually reach the market, including drugs for critical conditions. This gap between regulatory approval and real-world availability leaves patients and prescribing doctors navigating a system where the right treatment may exist on paper but not on pharmacy shelves.

Regional disparities compound the picture. Access varies significantly between urban and rural areas, between the mainland and the islands, and between those with private health insurance and those relying solely on the National Health Service. For anyone managing a chronic condition in Portugal — whether a lifelong resident or someone who relocated expecting a functional European healthcare system — the data is a reminder that affordability and availability remain uneven, and that reform of pharmaceutical pricing and distribution sits among the country's most pressing health policy challenges.