Gesundheit Österreich conducted an assessment of the performance of centralised procurement of medicines (CPM) in Portugal. The study, commissioned by the Directorate-General REFORM of the European Commission and accompanied by the Mission Structure for the sustainability of the Health Budget Program (EMSPOS), was largely informed by more than 40 interviews with key stakeholders in Portugal and an analysis of bids. The Portuguese system of CPM was found to have several strengths, such as its contribution to improved governance and transparency of processes as well as more equity in access to medicines across the country. However, lack of clarity related to the roles and responsibilities of involved institutions and lengthy and bureaucratic processes, resulting in delays in the conclusion of processes, undermine the CPM. The authors provide a set of policy recommendations, including a call for an updated procurement strategy.