From Sunday, November 1, 2026, CNAM insured persons may have to pay upfront for their medications in private pharmacies affected by the suspension of third-party payment. Announced by the Syndicate of Community Pharmacists of Tunisia (SPOT), this measure raises practical questions about payment, dispensing of treatments and reimbursements.
The union confirmed on Friday, October 30, its decision to suspend the third-party payment system due to lack of agreement with CNAM on contractual commitments and the settlement of amounts owed, according to its statements. It had alerted the fund and the involved parties as early as October 19. The announcement has already been reported by Tunisia Numérique. Here are the practical consequences and the points that remain subject to an official decision.
What to remember as of October 31
November 1: date announced by SPOT for the suspension of third-party payment at pharmacies.
October 19: date on which the union says it alerted CNAM.
Reimbursement: the new modalities applicable to insured individuals have not yet been detailed in an official announcement found as of October 31.
What does the halt of third-party payment mean for a patient?
Third-party payment allows eligible beneficiaries to obtain their medications in pharmacy without advancing the portion normally covered directly by CNAM, under the terms of their regime. With the announced suspension of this mechanism, an insured person could be required to pay themselves the price of medicines previously dispensed under this arrangement, then to seek reimbursement under the procedure that will be adopted.
However, it is important to distinguish the stopping of a payment method from the removal of a reimbursement right. The union’s press release does not constitute a decision removing the insured’s rights. It does not specify either the definitive procedures that will apply starting Sunday, nor any potential specific provisions for certain categories of patients.
Must one pay for all medications in full?
The immediate risk is a larger upfront cost for people who used third-party payment. The concrete amount will depend on the treatment, its price, and the conditions applied by the pharmacy. It would be premature to claim that all patients will automatically bear the entire expense under the same conditions.
Before going to renew a treatment, the insured may contact their usual pharmacy to know the actual dispensing and payment modalities applied. For regular treatments, it is also advisable to prepare the prescription and the usual health coverage documents.
Useful precautions in the pharmacy
Before purchase : ask whether third-party payment is maintained for your file and what amount will need to be paid.
At the counter : keep the prescription and request an invoice or a detailed receipt.
After purchase : also keep the medication vignettes if they appear on the packaging and inquire with CNAM about the required file.
In case of chronic treatment : do not discontinue a prescribed medication on your own initiative; seek advice from the doctor or pharmacist if access is difficult.
How to request reimbursement from CNAM?
SPOT states that it has sent a letter to CNAM to organize the processing of insured dossiers and facilitate access to medications. The union specifies that the official provisions will be communicated after receiving the necessary responses. As of October 31, one should not present a reimbursement pathway specific to this new suspension as definitively settled.
A precedent exists: during a suspension of third-party payment in December 2025, CNAM had announced an exceptional procedure for certain insured in the private sector. The file then included a completed reimbursement form, the prescription, the purchase invoice, and the medication vignettes. This 2025 measure does not automatically guarantee November 2026. It only shows which supporting documents may be useful to keep.
Why did pharmacists decide this suspension?
According to SPOT, payment delays and the non-compliance with contractual commitments undermine the cash flow of pharmacies. Representatives of pharmacists also cite tax pressure, supply difficulties and medicine shortages. They explain that their decision aims to preserve the ability of pharmacies to continue purchasing and dispensing treatments.
On October 27, the union’s extended national body confirmed the suspension, while leaving open the possibility of a negotiated outcome until the end of the week. In its Friday statement, the organization says that no satisfactory solution has been obtained. These grievances are those of the professional organization; they do not, on their own, constitute a contradictory assessment of the fund’s financial situation.
Chronic diseases: the essential question
The SPOT press release does not specify a definitive exceptional mechanism for people with chronic or severe illnesses. Insured individuals must request the concrete conditions for dispensing their medications and follow CNAM’s announcements. It would be inaccurate to state at this stage that all their prescriptions will continue to be reimbursed at the counter as before.
A decisive official announcement for the insured
The next expected step is the communication of the rules applicable to reimbursement dossiers and to the different insured profiles. In the meantime, the definite information is the suspension decision announced by SPOT starting November 1. Maintaining access to treatments and the ability to exercise reimbursement rights remain the practical priorities for patients.
