Summary:

On 5 January 2026, the Tunisian pharmacists’ union (SPOT) issued a communiqué highlighting the deepening crisis in the country’s pharmaceutical sector as the union’s agreement with the CNAM, the nationalized health insurance provider, expired and pharmacists await accumulating overdue payments.  

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In particular, SPOT pointed to persistent supply disruptions, prolonged payment delays, and nine months of unheeded warnings to authorities.  

The union raised concerns over national health priorities, including strategies to prevent medicine shortages, the establishment of unified pricing mechanisms, and the integration of pharmacy professionals in the National Agency for Medicines and Medical Devices.  

According to SPOT statement, the SPOT–CNAM agreement expired on 31 December 2025 while CNAM still owed pharmacies payments overdue by more than 185 days, leaving pharmacies financially exposed. These delays have strained pharmacy finances, increased employee burdens, and disrupted medicine distribution, particularly in regional and underserved areas.  

Adding to the issue, social protection expert Badr Smaoui noted that, despite a theoretical CNAM surplus of around 900 million TND, severe liquidity constraints are preventing timely payments to pharmacies and other healthcare providers. 

Additionally, the National Council of the Order of Pharmacists of Tunisia (CNOPT) issued warnings against the continuation of third-party payments without a formal legal framework, citing potential judicial consequences. SPOT reaffirmed its willingness to engage in responsible negotiations, highlighting the need for a structured and sustainable solution that safeguards both pharmacies and patient access. 

Outlook: 

As Tunisia enters 2026, the pharmaceutical sector faces continued vulnerability. Without timely structural reforms, pharmacies are likely to remain under financial pressure, supply disruptions may persist, and patient access, especially in lower-income regions, could be compromised.  

The dispute between CNAM and pharmacists is also likely to attract greater public scrutiny, especially from citizens who rely solely on government social programs, which could translate into rising public dissatisfaction and increased pressure on decision-makers.  

With other economic pressures already creating challenges for many Tunisian families, major disruptions in the accessibility of healthcare and medicines could prompt public outcry, protests, and other forms of organized opposition. 

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