The Portuguese Stroke Society (SPAVC) has voiced strong opposition to a recent decision by the Portuguese Ministry of Health that restricts the prescription of injectables and diabetes sensors to only four medical specialties. The society is calling for an urgent review of this measure, emphasizing that such limitations hinder the provision of comprehensive and patient-centered care, particularly as stroke is the leading cause of death in Portugal, and diabetes is one of its most significant modifiable risk factors.

Effective August 8th, physicians in the specialties of Endocrinology and Nutrition, Internal Medicine, Pediatrics, and General and Family Medicine are the only ones authorized to prescribe interstitial glucose monitoring sensors and medications from the GLP-1 receptor agonist class (such as semaglutide, dulaglutide, liraglutide, and exenatide). This class of drugs, which includes Ozempic, was developed to treat type 2 diabetes but is also being used to combat obesity and aid weight loss. The Ministry of Health justifies the measure by citing widely recognized difficulties in accessing these therapies and reports of their misuse, aiming to regulate and correct these distortions.

The SPAVC argues that limiting the prescription of effective therapies and technologies to a select few specialties compromises the necessary multidisciplinary and integrated approach to managing stroke. They further highlight that GLP-1 analogues also contribute to controlling dyslipidemia and hypertension and have demonstrated efficacy in reducing the risk of stroke and its recurrence. The association advocates for informed guidance for correct and timely prescription rather than restricting access for those who could benefit.

Regional Perspective

Portuguese medical societies, including the Portuguese Stroke Society and the Portuguese Society of Cardiology, are strongly opposing the restrictions placed on the prescription of vital diabetes medications and sensors. These societies emphasize that the exclusion of specialties like Neurology and Cardiology, which have played a pivotal role in the development of these therapies, undermines the effective management of patients with stroke risk factors.

Immediate Implications

Patients reliant on these therapies may face delays in accessing them due to the prescription restrictions.
Manufacturers of the drugs and sensors could face potential challenges in distribution channels and market access due to the regional healthcare policies.
There is an opportunity for companies specializing in diabetes management solutions and medical education to engage with physicians in the permitted specialties to offer support and information.

Analysis

This Portuguese decision marks a concerning development in healthcare policy, attempting to balance ensuring appropriate access to these crucial therapies with preventing their misuse. However, the chosen approach, which excludes key medical specialties, may lead to adverse outcomes in managing chronic conditions like diabetes and stroke. The efficacy of these medications extends beyond diabetes management to controlling multiple cardiovascular risk factors, making the exclusion of specialties like Cardiology and Neurology clinically illogical. Policymakers should reconsider these restrictions, taking into account scientific evidence and clinical recommendations from specialized medical bodies to ensure the best possible patient care.