Many Tunisian citizens and social security insured individuals face difficulties accessing medications, especially those for chronic illnesses. Badr Samawi, a social protection expert and consultant, outlined procedures for obtaining coverage for specific medications not on the official list. He discussed this on Express Fm on September 21, 2026, noting that when a medication is not on the list and the CNAM doctor does not approve, the insured can contact the Ministry of Social Affairs' consultative commission.
The consultative commission reviews requests for coverage of specific medications not initially on the official list and requiring authorization. According to Samawi, the commission meets weekly and must respond to the social insured within a month. If coverage is denied, patients can appeal to the social security judge at the court of first instance in their area of residence. This process aims to provide an alternative for patients needing specific treatments.
Statistics from CNAM show that half of the decisions to cover specific medications concern cancer diseases. After the medical commission's approval, these medications can only be obtained from health structures under the National Social Security Fund (CNSS). They are not available in private pharmacies due to their high cost and the need for careful management. This ensures that patients receive necessary treatments while controlling costs.
The CNSS distributes these medications through six of its health establishments. Recently, new centers were added in several regions, including Kasserine, Siliana, Mahdia, Jendouba, Gabès, and Médenine, and services were created in certain hospitals. This expansion aims to improve access to necessary medications across the country, reducing regional disparities in healthcare services.
Badr Samawi emphasized the state's role in controlling medications introduced to the Tunisian market, verifying their conformity to standards. He also stressed the need to regularly revise the list of covered medications to account for technological and treatment advancements. This would ensure that patients have access to the most effective and up-to-date treatments available.
A new financing mechanism was introduced in the 2026 finance law, modifying the name of the "Account for Diversification of Social Security Regime Financing Sources." This account now finances specific medication expenses from fiscal revenues, rather than from CNAM contributions. This change aims to improve the management and funding of essential medications for patients.
Badr Samawi called for revising the medication list, accelerating consultative commission work, and streamlining procedures. He noted that patients resorting to justice is a "negative indicator," highlighting the need for efficient and effective systems to support those in need of specific treatments. This would enhance the overall quality and responsiveness of the healthcare system.
Key points
- Patients can appeal to the Ministry of Social Affairs' consultative commission for coverage of specific medications not on the official list.
- The consultative commission must respond to insured individuals within a month.
- The state now finances specific medication expenses from fiscal revenues, not from CNAM contributions.
