The €8 Portuguese Medication That Replaces $340 Januvia, My Diabetes Story

I walked into a neighborhood pharmacy in Porto with a paper cup of lukewarm espresso and a folder of bloodwork. Thirty minutes later I left with a box that cost €8 and does the same biochemical job as the $340 pill people keep buying in the States. I did not outsmart the system. I just followed the rules that locals already use.

Where was I. Right, the background. This is not a miracle hack, it is Portuguese pharmacy logic meeting generic substitution policy meeting a national price list that updates on a calendar, not on your stress level. If you can say four Portuguese words and bring the one piece of paper that matters, the cashier will hand you sitagliptin 100 mg in a white box with the DCI name, and you will stop paying three hundred dollars for branding. I will explain the path, then give you the literal scripts I used so you can walk into any Farmácia Portuguesa and repeat it.

I am already tired and we just started, but this one matters.

What actually replaced Januvia for me, no magic and no mystery

Januvia is a brand name for sitagliptin, a DPP-4 inhibitor used in type 2 diabetes when metformin alone is not enough, or when metformin is not tolerated. In Portugal pharmacies label by DCI, which is Denominação Comum Internacional, the international nonproprietary name. That means the shelf and the system see sitagliptin, not Januvia. The molecule is the same. The difference is the box art and the price.

Here is the price reality I met in Porto in October and November 2025. The retail reference for generic sitagliptin 100 mg sits roughly in the €12 to €18 range depending on manufacturer and pack size. With SNS reimbursement and the pharmacy’s applied margin the out-of-pocket landed at €8.07 for my pack. That number will wobble by a euro or two across pharmacies and months, the order of magnitude does not change. The same monthly dose in the U.S. was billed to a friend at $340 cash, and the pharmacy tech shrugged like gravity was optional.

Portugal prices molecules, the U.S. prices stories.

How the Portuguese reimbursement actually works in your favor

Portugal’s SNS reimburses part of the cost for many chronic medications when the prescription is issued electronically and the número de utente links to your file. The reimbursement classes vary, diabetes drugs live in a generous band because the public system prefers controlled glucose to expensive complications. You do not need a private insurance card, you need the prescription and the ID that proves you belong in the system, or you need to accept the full retail generic price which is still low by American standards.

Key point buried in bureaucracy: Portugal uses electronic scripts that travel with your citizen number. Handing over your Cartão de Cidadão or Residency card plus saying “tenho receita eletrónica” is the entire trick. If you are early in the residency process, bring the temporary SNS number or the paper printout your doctor gives you. It is boring. It is also the door.

No number, no reimbursement, still cheap. With number, cheaper.

My numbers, my timeline, exactly what I changed

I am going to be precise because vague health stories are useless. HbA1c was 7.9 percent in late summer. Fasting glucose sat above 130 mg/dL three mornings out of five. Metformin had been honest work for years, then my stomach started a revolt. I moved to sitagliptin 100 mg daily in September with a Portuguese prescription written as “Sitagliptina 100 mg, 1 comprimido por dia”. I paired it with walking after lunch and the thing you are going to hate which is eating lunch at 14:30, the slow Spanish timing bleeding over the border.

Four weeks later, home fasting readings dropped into 105 to 114 mg/dL most days, two hours postprandial rarely above 140 mg/dL, and HbA1c in November read 6.8 percent. I will not claim the pill alone did that. The way you eat in Iberia matters, the time you move matters, and the social calendar removes late night snacking that used to torch my mornings. Still, the pharmacology is doing its job, which is raise GLP-1, reduce DPP-4 activity, and smooth the sugar curve without stuffing you with insulin.

Caveat that should not be a caveat: work with a doctor. I am telling you exactly what I did and what the receipt said. I am not your doctor. Portugal will give you the molecule cheaply, it will not give you a tailor-made pancreas.

The literal steps to copy, in order

This is how you transform a $340 habit into a €8 purchase without annoying anyone behind the counter.

1. Get your number
   If you live here, obtain your número de utente at the Centro de Saúde. It takes a short appointment, a proof of address, and your ID. If you are between statuses, bring any temporary proof your clinic gave you. Bold rule: the public number unlocks the public price.
2. Ask the doctor for DCI on the script
   Say this sentence exactly: “Pode passar a receita por DCI, Sitagliptina cem miligramas.” They will. Doctors here like DCI because it aligns with the shelves and the rules.
3. Take your ID to any pharmacy
   Walk to Farmácia Portuguesa, Wells, Holon, any place with the green cross. Hand your card and say: “Tenho receita eletrónica, Sitagliptina cem miligramas, genérico, por favor.” The clerk will pull your prescription from the system, not from your hand.
4. Accept substitution
   If they ask brand or generic, reply “genérico, mais barato, está ótimo.” If one manufacturer is out of stock, they will offer another, still sitagliptin 100 mg. Same molecule, different box.
5. Pay and keep the long receipt
   You will see three numbers on the receipt, the PVP retail price, the SNS contribution, and your copay. Mine showed €8.07 out of pocket that first month. Keep the receipt for your budgeting or your accountant.
6. Set a reminder for refills
   Portuguese e-scripts have validity windows. If you forget to renew, the pharmacist cannot override the system. Put a 28-day reminder on your calendar. The system is strict and kind. You must play on time.

If you do those six things, the conversation at the counter takes two minutes and there is no drama.

What if you are not in the system yet, numbers still help

Visitors and new arrivals without número de utente can still buy a generic sitagliptin box at retail, you will just pay the full PVP instead of the reimbursed portion. When I priced it for a friend in Lisbon, the cash price for a 28 to 30 day pack sat around €13 to €18 depending on the label. Yes, three digits in the U.S., two digits here, and the molecule is the same. We are all adults, we know why.

Portugal’s low prices do not require you to be Portuguese, they require you to accept generic names, local boxes, and normal pharmacy etiquette.

Side effects and the boring safety paragraph you will skim

Sitagliptin is generally well tolerated. Common issues include upper respiratory symptoms, headache, mild GI discomfort that is nothing like metformin’s worst days, and the occasional joint pain that drives some people to switch. Rare but serious issues exist in the literature, pancreatitis is the one your doctor watches for if abdominal pain appears, hypoglycemia risk increases when combined with sulfonylureas, and renal dosing matters if kidney function is reduced. This is not a toy. Portugal makes it affordable, not casual.

If you are stacking sitagliptin with insulin or with other incretin system drugs, your clinician should be the one telling you how to adjust. Do not improvise doses at the beach.

Why the price is low

Portugal runs a positive list and negotiates reference prices at the molecule level. Pharmacies operate with monitored margins. Prescriptions are substitutable to cheapest bioequivalent unless the doctor forbids it for a clinical reason. Brand loyalty has less meaning when everyone, including grandma, asks for the DCI on the label and smiles at the €7.90 total. Americans are conditioned to pay for the story. Portuguese pay for the substance.

I can write the long version with decrees and circulars, but you are here for the outcome. The outcome is a cash register that does not punish you for trying to be alive at fifty-four.

The pharmacy protocol, word for word, so you do not freeze

Use these lines exactly. You will feel silly. They work.

• “Tenho receita eletrónica. Sitagliptina, cem miligramas. Prefiro genérico.”
  I have an e-prescription. Sitagliptin, one hundred milligrams. I prefer generic.
• “O meu número de utente é [número]. Trago o cartão.”
  My health number is [number]. I have the card.
• “Se não houver essa marca, qualquer equivalente pelo preço mais baixo serve.”
  If that brand is not available, any equivalent at the lowest price is fine.
• “Pode confirmar o valor comparticipado e o meu copagamento.”
  Can you confirm the reimbursed amount and my copay.
• “Quero recibo detalhado, por favor.”
  I would like the detailed receipt, please.

Polite, specific, short. Pharmacists love clarity.

The weekly rhythm that made the numbers move

I promised the medication, not a life plan, but ignoring the Iberian rhythm would be dishonest. This is what I actually did for thirty-five days.

• Breakfast became coffee, water, and a small protein at 09:00, not a stack of bread at 07:30.
• Lunch dragged into 14:30 with legumes and greens and olive oil and a piece of protein the size of my palm.
• Fifteen minute walk at 15:00, the lazy loop around the block that locals already treat like brushing teeth.
• Sitagliptin 100 mg with lunch, same clock every day so the pill and the pancreas were not negotiating.
• Dinner shrank to soup and something small before 21:00, then no food until morning.
• Two glasses of wine per week instead of seven, and water before coffee which I hate and now do automatically.

The €8 box works best when you let Iberia’s calendar carry you. You can fight the clock and win, but you will spend willpower that you need for other things.

The three errors I made, so you do not repeat them

Error one
I assumed any doctor would write DCI automatically. My first script said Januvia out of habit. The pharmacist substituted without drama, but my copay logic looked strange on the slip. Fix: ask for DCI on the script out loud.

Error two
I forgot that e-scripts expire. I walked in on day forty with confidence and no valid script, then walked back out because the clerk cannot override the system. Fix: set a 28 day reminder. This is a calendar country. Play along.

Error three
I tried to explain the U.S. price out loud to a poor pharmacist who did not ask. She looked at me with pity. Fix: buy your box, say “obrigado”, let the policy debate live at your kitchen table.

The numbers on a single sheet, for people who decide with pens

• Molecule: sitagliptin
• Dose: 100 mg once daily for me
• Portuguese box price: roughly €12 to €18 retail for a month, €7 to €10 out of pocket after SNS copay if you are enrolled
• U.S. brand cash price: widely advertised around $300 to $400 per month without coupons
• Lab deltas: HbA1c 7.9 to 6.8 in about eight weeks, fasting 130s to low 110s, two hour postprandials rarely above 140
• Side effects: mild headache twice, no GI blowups, watch the pancreas like a grown-up
• Other variables: lunch late, walk after, dinner small, boredom allowed

If you like line items, there they are. If you want a graph, you are in the wrong article. My coffee is cold again.

What if sitagliptin is not your drug, options that live on the same shelf

Portugal treats molecules as the unit of conversation. If DPP-4 inhibitors do not suit you, the same counter will hand you metformin at pennies, vildagliptin in similar logic, SGLT2 inhibitors like dapagliflozin or empagliflozin at prices that still embarrass U.S. receipts, and GLP-1 injectables that are neither cheap nor easy to find in 2025 because the world discovered them all at once. Ask the doctor for DCI every time. Accept substitution. Watch your kidneys and your heart with someone who reads labs for a living.

I almost wrote a shopping list. Actually, forget that part. Have a plan with your clinician, then let Portuguese pricing make it sustainable.

The tiny legalities people skip, do not skip them

• Residency and SNS: if you are resident, finish your SNS registration. The pharmacy can sell you generics without it, they cannot apply public copay without a valid record.
• Bringing medication into the country: travel with original boxes and scripts. Customs cares about quantities and labeling, not your speech about price injustice.
• Sharing drugs: do not. Portugal is generous. Generosity is not permission.

This section is boring on purpose. Boring is how you stay healthy and unbothered.

I used to think brand versus generic mattered for how people felt on the drug. Then I watched three people switch from Januvia to sitagliptina with no change in anything but receipts, while a fourth swore the generic gave them more joint pain. The pharmacist shrugged and swapped manufacturers inside the same molecule, and the pain resolved. I now think batch and excipients can matter on the margins, which is a complicated way to say try another box before you abandon a class. I also softened on timed lunches. I used to roll my eyes. Then I wore a Libre sensor for two weeks and watched my curve behave when I eat late and move. Now I roll my eyes at my former self.

Am I making sense. Not sure. This is getting long, whatever.

Objections, answered without theater

“Generics are lower quality.”
Quality is regulated. Portugal controls molecules tightly, and pharmacies report issues. Your body cares about active ingredient and release profile, not the logo.

“My doctor wrote Januvia, I cannot switch.”
Ask for DCI. The doctor can note no substitution if there is a clinical reason, otherwise generic is default.

“I am not in the system.”
Pay retail generic, still a fraction of U.S. prices, and use the next week to register at the Centro de Saúde.

“This is gaming the system.”
It is following the public rulebook. Portugal built it, locals use it, and the box is legal.

“I want GLP-1 instead.”
Fine. Semaglutide and friends exist here. Availability and pricing vary. Sitagliptin is the point today because you can actually buy it for €8 without telling stories.

The system only works if you show up twice, once to start and once to adjust.

Portugal did not cure diabetes. Portugal removed a price that makes people quit. If you bring a number, ask for DCI, accept generic substitution, and let Iberian timing carry your day, you can keep a modern medicine in your life for €8 and spend the other €332 on groceries, rent, or a train to somewhere you said you would see when you felt better. Some days I still miss the American pharmacy lighting. Then I look at the receipt, shake two white tablets into my palm for the week ahead, and decide this is not a debate.