Only physicians specialising in endocrinology and nutrition, internal medicine, paediatrics, and general and family medicine are authorised to prescribe interstitial glucose monitoring sensors and medications in the GLP-1 receptor agonist class (semaglutide, dulaglutide, liraglutide, and exenatide).
This class of drugs includes Ozempic, developed to treat type 2 diabetes, but which is also being used to combat obesity and aid weight loss.
In the order establishing the measure, the Ministry of Health justifies the decision with “the widely recognised difficulties” in accessing these therapies and reports of misuse of these resources. The objective is to “regulate and correct these distortions, promoting effective and adequate access to these essential health tools.”
For João Raposo, president of the Portuguese Society of Diabetes, the measure is important “because it attempts to find a solution,” but it is “a sticking plaster on the current situation.”
Too little, too late
“This measure was important to take, but it has come late,” because there was no prior planning on how to guarantee access to these technologies for the diabetic population, nor was there any thought given to what to do regarding the obese population, the endocrinologist told Lusa news agency.
João Raposo said he believed it will be difficult to predict whether the measure would solve the problemsthat diabetics have faced over the past three years in accessing medication and technolo
“We are eager to see if [the measure] will simplify or facilitate access.” Personally, I have some doubts, because I believe the number of prescriptions outside of these specialties is not significant,” he noted.
The specialist also expressed concern about patients currently treated by other medical specialties, questioning whether they will be able to continue benefiting from the therapy and how quick access to appointments with authorised prescribing physicians will be guaranteed.
He also argued that it is “very important” that Infarmed and the government monitor the real impact of the measure, but warned that the “most important” thing is to ensure that all diabetics have access to this type of medication, regardless of their body mass index, which will require changes to current legislation.
He also emphasised that neither the Portuguese Society of Diabetes nor patient associations oppose the prescription of these medications for people with obesity.
On the contrary, he said, they “clearly” advocate that the government must urgently regulate access to obesity consultations and the provision of these therapies.
According to the specialist, the lack of a structured response has allowed “the opening of a market for abnormal prescriptions and the lack of follow-up for these people.”
“What happens in these situations is that people may be overweight, obese to varying degrees, and they may take these therapies for a month, two months,” then they stop and start again, and this is not recommended from a clinical standpoint.
João Raposo warned that “an important problem”—obesity—is being devalued, allowing the market to operate: “Healthcare cannot be subject to the laws of the market, because we know it is very tempting for this population, which desperately seeks solutions. The market worked, and we shouldn’t have let that happen.”
For João Raposo, the only way to overcome this situation is to create effective mechanisms to monitor people with obesity, recognised as a disease in Portugal since 2004.
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