The availability of medicines in general

The Portuguese system provides five different levels of participation of patients in the cost of medicines. Depending on the situations[1], the state contributes, 100% (only in very special situations defined by a Health Minister decree, when the drugs are indispensable to sustain life), 95% (level A) 70% (level B), 40% (level C) or 20% (level D) of the cost of medicines, and patients or carers are only required to pay the remaining costs. The degree of contributions is fixed in several official lists drawn up by the health services.

The contributions by the state can be increased by 10% for generic medicines and by 5%, in the level A (95%) and in the levels B, C and D by 15%, for pensioners whose annual total income is less than 14 times the minimum wage.[2]

The availability of Alzheimer treatments

All four anti-dementia drugs are available to patients in Portugal and are part of the reimbursement system. They are classified as level C drugs and the State covers 40% of their costs.

Portugal limits both initial and continuing treatment decisions to neurologists and psychiatrists. It does not require any specific diagnostic examinations to be carried out, nor does the system provide upper or lower treatment limits.

Finally, the Portuguese system reimburses medicines for people living alone or in nursing homes.

[1] Infarmed (National Pharmacy and Medicines Institute) has no general criteria to decide the level of reimbursement of any drug. There are diseases whose drugs (specific or not) are all totally reimbursed. Usually they follow a cost/benefit evaluation. A drug can be excluded from the reimbursement system based on its excessive cost. Infarmed has a large discretionary power in this matter.

[2] European Commission (2006): MISSOC – Mutual information system on social protection : Social protection in the Member States of the European Union, of the European Economic Area and in Switzerland : Comparative tables