The Tunisian government has suspended payments to private pharmacies participating in the third-party payment system, known as "tiers payant". The decision was announced by Minister of Social Affairs, Issam Lahmar, on November 5, 2026, during a parliamentary health commission meeting. The move comes after the Tunisian Syndicate of Private Pharmacy Owners announced on October 30, 2026, that it would suspend the third-party payment system from November 1, 2026, citing unpaid claims and contractual breaches by the National Health Insurance Fund (CNAM).
The dispute between the Ministry of Social Affairs and private pharmacies has been ongoing. In July 2026, pharmacy owners threatened to suspend the third-party payment system if CNAM did not settle its financial and contractual obligations. At that time, outstanding claims for two months of 2025 reimbursements were estimated at around 80 million dinars, according to Zoubeïr Guiga, president of the syndicate. The latest decision by the minister means that payments will remain blocked until pharmacies lift their suspension of the third-party payment system.
The Tunisian Syndicate of Private Pharmacy Owners had justified its decision to suspend the third-party payment system due to persistent delays in payments and what it sees as CNAM's failure to meet its contractual obligations. The syndicate had warned CNAM as early as October 19, 2026, that it could no longer continue with the system without settlement of outstanding claims. The organization also highlighted difficulties in supplying medicines, tax pressure, and structural problems faced by the profession.
This is not the first time pharmacies have suspended the delivery of medicines under the third-party payment system. In December 2025, they took similar action amid tensions over CNAM debts and sector financing. The current blockade of payments could prolong tensions, directly affecting social security beneficiaries who rely on the third-party payment system.
Minister Lahmar's decision was made just hours before a tranche of owed sums was due to be paid out on November 3, 2026. The move adds a new dimension to the standoff between the authorities and pharmacists. The dispute highlights the challenges facing Tunisia's healthcare system, including the financial sustainability of CNAM and the working conditions of healthcare providers.
The third-party payment system, or "tiers payant", allows patients to obtain medicines without upfront payment, with CNAM covering the costs. The suspension of this system by pharmacies and the government's response have raised concerns about access to healthcare for vulnerable populations. The situation remains uncertain, with no clear resolution in sight.
The blockade of payments to private pharmacies has significant implications for the Tunisian healthcare system. Patients may face difficulties accessing essential medicines, while pharmacists and healthcare providers may struggle to maintain their services. The government and CNAM must work with pharmacy owners to resolve the dispute and ensure the continued provision of healthcare services to those in need.
Key points
- The Tunisian government has suspended payments to private pharmacies participating in the third-party payment system amid a dispute over unpaid claims and contractual obligations.
- The dispute highlights the challenges facing Tunisia's healthcare system, including the financial sustainability of CNAM and the working conditions of healthcare providers.
- The situation remains uncertain, with no clear resolution in sight, and may have significant implications for access to healthcare for vulnerable populations.
