After several days of uncertainty surrounding the fate of reimbursement of medicines for common illnesses, the National Health Insurance Fund (CNAM) and the Tunisian Union of Private Pharmacists tried to ease tensions. If the continuity of reimbursement is now confirmed, the basic conflict between the two parties remains unresolved, revealing a crisis of confidence which is getting bogged down.
Confusion cleared, tension maintained
In a press release published Tuesday evening, the Tunisian Union of Private Pharmacy Owners wanted to reassure policyholders affiliated to the family doctor system: they can continue to obtain their usual medications in pharmacies and benefit from reimbursement by the CNAM, in accordance with the procedures in force.
This clarification responds to the confusion caused by a series of successive press releases. The CNAM had announced that, exceptionally, policyholders covered by the private therapeutic system could still benefit from reimbursement of medications for common illnesses, while administrative disputes were resolved.
A contractual standoff
At the origin of the conflict: the decision of the Pharmacists’ Union, taken during its extraordinary session of October 25, not to renew the direct payer agreement for 2026 and to suspend this system for common illnesses from October 27.
The pharmacists denounce the repeated violations of the current agreement, the closure of dialogue with the CNAM and the non-compliance with the commitments made during the last bilateral meetings.
In response, the CNAM accused the union of having acted unilaterally, outside of the deadlines and legal procedures provided. She reaffirmed that the direct payer system continues to operate with pharmacies that do not apply the suspension decided by the Order.
Pharmacists demand guarantees
The Order of Pharmacists, for its part, insisted on the continuity of reimbursement and the direct payer system, while recalling that professionals in the sector have, for years, alone assumed the consequences of delays and failures by the CNAM.
The organization calls for an institutional and lasting solution, in order to prevent citizens from being taken hostage by this disagreement.
A symptomatic crisis in the health system
Behind this contractual dispute lies a broader crisis in the governance of the Tunisian health system, where financial tensions between public and private actors are increasing.
The CNAM seeks to contain its deficits, while pharmacists demand viable working conditions and on-time payments.
While waiting for a clear renegotiation of the sectoral agreement, distrust remains palpable and dialogue still suspended.
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