Escalating Public Spending: Semaglutide Off-Label Use Sparks €250 Million Fraud Investigation in Portugal

Semaglutide off-label use for weight loss is at the centre of a suspected €250 million fraud uncovered by Portugal’s Judicial Police within the National Health Service (SNS). According to the investigation reported on 15 April 2026, roughly half of all public spending on Ozempic (semaglutide) between 2020 and 2025 was directed at non-diabetic patients seeking to lose weight rather than at individuals with type 2 diabetes, its approved indication.

Explosive Spending Growth

SNS expenditure on semaglutide-class medicines soared 285% in five years, climbing from €23.2 million in 2020 to €135.5 million in 2025, for a cumulative total of approximately €505 million. The Judicial Police estimates that more than €250 million — half of this total — funded semaglutide off-label use in people without diabetes.

In one striking case, an endocrinologist in Porto was arrested in 2025 for allegedly defrauding the State of over €3 million by issuing prescriptions for Ozempic to non-diabetic patients. With the medicine reimbursed at 90%, patients paid only €10–11.50 per package instead of the €110–115 list price, creating a powerful incentive for misuse.

Reimbursement Rules Clearly Breached

Infarmed, Portugal’s medicines regulator, authorises Ozempic strictly as second- or third-line therapy for adults with type 2 diabetes, alongside diet and exercise. Reimbursement was widened in February 2026 to also cover diabetic patients with obesity or high cardiovascular risk. However, police analysis of prescription, diagnosis and spending databases showed that a large proportion of reimbursed packs lacked any diabetes diagnosis, confirming widespread semaglutide off-label use.

The surge in off-label prescribing contributed to repeated shortages, leaving many patients with genuine diabetes unable to obtain their medication. The case highlights the urgent need for tighter controls, such as diagnosis-linked electronic prescribing and indication-specific reimbursement codes, to protect both public finances and legitimate patient access.