Private medical laboratories to suspend third-party payment with CNAM from 13 July

Tunisia's private medical analysis laboratories will stop applying the third-party payment scheme with the Caisse Nationale d'Assurance Maladie (CNAM) from Sunday 13 July 2026, the Syndicat tunisien des biologistes privés (STBP) announced on Wednesday 1 July.

Under the tiers payant system, patients present their CNAM card at a private laboratory and pay nothing upfront; the insurer reimburses the laboratory directly. Once the suspension takes effect, most patients will be required to pay the full cost of tests at the time of their appointment and then seek individual reimbursement from the CNAM themselves — a process that can take several weeks.

The STBP said the decision followed a financial crisis that has persisted for several months, with the CNAM failing to settle amounts owed to laboratories for more than seven months. The union held an extraordinary general assembly on 30 June 2026 at which it voted to suspend the scheme in all its forms — covering both ordinary illness and chronic conditions.

One category of patient is explicitly protected. The STBP said blood tests and analyses will continue to be carried out without charge for all insured patients affiliated to the médecin de famille (family doctor) regime, without exception.

Wider crisis across private healthcare

The laboratories' move is the latest in a series of threatened and enacted suspensions across Tunisia's private health sector, all driven by CNAM payment delays. The Syndicat tunisien des pharmaciens d'officine had earlier threatened to suspend prescription coverage from 1 July; the CNAM on Wednesday committed to paying part of the sums owed to pharmacists, averting that stoppage for now, though pharmacist representatives described the arrangement as provisional and called for structural reform of the fund's financing.

The crisis has spread beyond pharmacies and laboratories. Representatives of wholesale pharmaceutical distributors joined both groups at an emergency meeting convened by the Conseil national de l'Ordre des pharmaciens de Tunisie (CNOPT) on 30 June, where participants described a severe financial stranglehold affecting the entire healthcare supply chain. The CNOPT established a permanent crisis unit to monitor the situation and coordinate next steps.

The STBP said it had repeatedly petitioned the Presidency of the Government, the Ministry of Social Affairs and the CNAM's directorate-general, without receiving a concrete official response. The union added that laboratories have continued to meet their own tax and social-security obligations on time — including on revenues not yet received from the CNAM — while also facing rising costs for reagents and medical equipment.

What it means for patients

Expats, foreign residents and visitors who rely on private laboratories for blood work or diagnostic tests under CNAM coverage should note the 13 July date. From that point, those not on the médecin de famille scheme will need to pay upfront and submit reimbursement claims independently. Patients on long-term or chronic-condition treatment plans are advised to check their coverage status with their laboratory before that date.

The STBP said the measure is directed at the CNAM and not at patients, stressing that its objective is to preserve laboratories' financial viability and the continuity of health services. It called on the competent authorities to settle outstanding debts urgently and put durable solutions in place to prevent the crisis from recurring.

The CNAM had not issued a public response to the STBP communiqué by the time of publication. Times of Tunis has sought comment.