The Portuguese Society for Obesity and Metabolic Diseases Surgery (SPCO) has welcomed the state co-payment of obesity medicines but is asking for changes to the ordinance that leaves its specialists out of the prescribing rules, according to Canal S+.
The government published Ordinance No. 464/2026/1 on 22 October, setting up a special co-payment scheme for medicines used to treat obesity. Under the scheme, the national health service will cover 15% of the price of these medicines, Público reported.
In a statement, the SPCO called the move an important step toward treating obesity as a chronic, complex condition with many contributing factors. It also said the change improves patients' access to the different treatment options available.
Why it matters
The ordinance sets who may prescribe the co-paid medicines, and that list does not include surgeons. The SPCO says this leaves out doctors who assess patients, help decide their treatment plans and follow them over time.
The society has long argued for a multidisciplinary approach to obesity, based on the best scientific evidence and bringing together nutritional, behavioural, pharmacological, endoscopic and surgical treatment. It says the prescribing rules sit awkwardly with that model.
The dispute comes as several patient and medical groups question whether the new measures go far enough. The platform Recalibrar a Balança has called for concrete steps to speed up the fight against obesity, Jornal Médico reported. The Portuguese association of people living with diabetes, APDP, has warned that the measures are insufficient for access to obesity treatment, according to netfarma.pt. Euronews reported that patients consider the eligibility criteria tight.
Who can prescribe under the new rules
The ordinance limits co-paid prescriptions to specialists in Endocrinology, Internal Medicine and Pediatrics working within the care structures set out in the Integrated Care Pathway for People with Obesity (PCIPO).
The SPCO said it is deeply concerned by this restriction. In its view, it fails to properly recognize the role of surgeons with training in obesity treatment, who take part in clinical assessment, in setting treatment strategy and in long-term follow-up.
The society stressed that it is not challenging the role of endocrinologists, internists or pediatricians in obesity care, nor the eligibility and monitoring criteria in the new scheme. It argues instead that the ability to prescribe should reflect a doctor's competence and training in obesity treatment, whatever their original specialty.
Surgery and drugs described as complementary
The SPCO rejected the idea that drug therapy and metabolic and bariatric surgery compete with each other. It described them as complementary, and said they can be used one after the other or together, depending on each patient's clinical needs.
The society questioned the logic of backing a multidisciplinary model while excluding from co-paid prescribing one of the medical specialties most involved in treating these patients.
It is asking the Ministry of Health to revise the ordinance so that general surgeons with training in obesity treatment, working within Multidisciplinary Obesity Teams (EMO), can prescribe under the same criteria as other doctors.
The SPCO said it is willing to work with the Ministry of Health, the Directorate-General for Health and other scientific societies on an integrated care model. It said the aim should be to give every patient access to the most suitable treatment at the right time, through multidisciplinary teams that draw on all the relevant clinical skills.
The ordinance took effect after its publication on 22 October. The 15% co-payment figure was reported by Público.
Watch for the Ministry of Health's response to the SPCO's request to widen prescribing rights to trained surgeons working in multidisciplinary obesity teams.
