"This is not about having the patient at the center; it narrows access, and we cannot assume that obesity, with the impact it has, with the prevalence it has, will all be treated pharmacologically in hospital care," the president of the Portuguese Association of General and Family Medicine, Nuno Jacinto, told Lusa.

The official was speaking about the Integrated Care Pathway for People with Obesity (PCIPO), from the Directorate-General of Health (DGS), which defines all the steps these people will have to take within the National Health Service to access medication to treat obesity, which currently requires a prescription and is not subsidised.

“Not clear”

Nuno Jacinto considers that this document "is not clear" regarding the responsibilities for prescribing these medications, as it initially allows for prescription in primary care, but then assigns the responsibility for prescribing to doctors in the hospital care unit, specifically the specialties of Endocrinology, Internal Medicine, and Paediatrics.

“To assume that it was a multidisciplinary obesity consultation within health centres was strange, because it was the same as me telling a patient who is here with me today, ‘I am your family doctor, let's talk about diabetes, let's talk about hypertension, cholesterol, osteoarthritis, but about obesity, go to a colleague's consultation tomorrow, or in a week, because I am not able to see you,’” explained Nuno Jacinto.

With this strategy, he said, patients are being “cut into slices”: “Now we follow this path for obesity, then we follow a path for diabetes, a path for hypertension, but we forget that the person is the same,” he added.

He considered that it makes no sense for the family doctor not to be able to prescribe these medications, explaining that they are identical to those for diabetes, which they prescribe today: “That famous cliché of the patient at the centre of the journey and care is not happening.”

“If it’s a financial issue, then let’s assume, as a State, that we don’t have the money to treat all obese people and we will only treat the most severe cases (...). We can’t resort to subterfuge,” he stated.

Financial impact

According to the analysis of the budgetary impact of co-payment for obesity treatment medications carried out by Infarmed, the State would spend at least between €194.8 and €954.4 million to co-pay for these medications for two years for the 170,405 patients who meet the criteria defined in the PCIPO to access the medication.

These figures take into account contributions between 15% and 90%, with the higher value representing almost half of the total spent by the SUS (Portuguese Public Health System) on medications between January and September of this year (€2,381.4 million).

In the prescription criteria indicated, Infarmed points to physicians from hospital care units belonging to multidisciplinary obesity teams (EMO) in the National Health Service, alluding to the PCIPO (Program for the Control of Obesity and Metabolic Syndrome).

In the study, Infarmed analyzed the costs of co-participation in both this scenario – users meeting PCIPO criteria (between 170,405 and 180,880) – and in the case of the estimated adult population (between 25 and 74 years old) with obesity, which reaches 2,008,386, according to the National Health Survey with Physical Examination (INSEF).

If the co-payment included the estimated two million+ obese adults in Portugal, the cost of co-paying for these medications – considering two years of treatment with all patients starting at the same time – could range between €2.296 million and €11.248 million, almost five times more than the National Health Service (SNS) spent on medications between January and September of this year (€2.3814 million).