The Union of Community Pharmacists of Tunisia (Spot) sounded a red alert on Monday, December 22, 2025: faced with late payments from the National Health Insurance Fund (Cnam) and the non-recording of invoices, the pharmaceutical sector is facing an unprecedented crisis which threatens citizens’ access to medicines, the sustainability of pharmacies and the stability of the health system.
Le Spot published a press release on the same day in which it expressed its concerns about the management of Cnam and the consequences of the financial crisis affecting the pharmaceutical sector.
The union emphasizes that, despite the upcoming holding of a working meeting with the Cnam, under the supervision of the Ministry of Social Affairs, trust between the parties has been deeply eroded. “ The Cnam unfortunately continued to undermine confidence by not recording the invoices issued by pharmacists over the past month. A serious and unacceptable act, which can only be interpreted as an attempt to hide the true extent of the debts before this meeting “, we read in the press release.
The union insists on the impossibility of pursuing a serious partnership in a climate where “ trust is destroyed and commitments devoid of content », while specifying that he will go to this meeting without preconditions, but with three fundamental principles:
- Guarantee the effective and continuous availability of medicines, to protect the citizen’s right to access to care.
- Ensure the sustainability of the pharmaceutical sector, by safeguarding the dignity of pharmacists and their ability to fulfill their public health role, in particular through the full execution of the sixth amendment to the sectoral agreement.
- Maintain the stability of the National Health Insurance Fund, protected from one-off measures or band-aid solutions that could threaten its balance and credibility.
Le Spot warns that pharmacists should not be considered the weak link in the chain and denounces any attempt to make them bear the cost of dysfunctions which are not attributable to them. He also recalls that all parties involved are responsible for the consequences of this situation on the health system and on access to medicines for citizens.
A context of persistent tensions
This new position taken by Spot takes place in a context of prolonged conflict between pharmacists and the Cnam. On December 15, 2025, the union had already published a press release to clarify its position following the suspension of third-party payment, a measure imposed by the absence of a clear legal framework, recurring payment delays and the absence of guarantees or a precise program.
Le Spot then insisted on the fact that this suspension was not intended to penalize citizens but was the result of dysfunctions in the system, which endanger pharmaceutical safety and weaken a profession already tested by failing financial and regulatory policies. The union also pointed the finger at the presidency of the government, as well as the ministries of Social Affairs and Health, accused of not having assumed their responsibilities despite repeated warnings.
This crisis arose from the failure of negotiations between Spot and Cnam concerning late payment of pharmacists’ debts. After the announcement of the suspension of third-party payment, effective since December 8, 2025, the Cnam had put in place an exceptional measure allowing socially insured people to be reimbursed for the costs of medicines paid in private pharmacies.
The National Council of the Order of Pharmacists of Tunisia (CNOPT), for its part, deplored the immediate repercussions on access to care, particularly for low-income patients, while understanding the decision of pharmacists, faced with payment delays sometimes reaching 150 days, while the initial agreement provided for payment within fourteen days. These prolonged delays have weakened the cash flow of pharmacies, complicated the payment of suppliers and the Tunisian Central Pharmacy (PCT), and put certain pharmacies, particularly in the interior regions, at risk of bankruptcy.
A crisis that threatens medicinal sovereignty
For several months, pharmacists have been warning about the accumulation of unpaid debts and the harmful effects on the drug chain. According to them, this situation constitutes a real structural crisis which endangers the country’s medicinal sovereignty and citizens’ access to essential care.
The press release of December 22, 2025 thus marks a new call to order from the authorities and underlines the urgency of reestablishing a stable and reliable framework to guarantee the continuity of the pharmaceutical service in Tunisia, while protecting the rights of patients and the sustainability of pharmacies.
I.N.
