Three hundred medicines, one circular, and no agreement on how far prices rose
On July 24 the Pharmacie centrale de Tunisie published circular 30/2026, revising the prices of around 300 medicines. Only in early August, when comparisons between old and new prices began circulating, did the scale become visible and the argument break out. The dispute is not only over whether prices should rise, but over how large the rises were and who was allowed into the decision.
Where they agree
All five start from the position that the Central Pharmacy is in serious financial difficulty and that the pharmaceutical system needs reform. None of them argues the current financing arrangement can continue unchanged. Even those defending the revision describe it as insufficient rather than as a solution.
Where they split
The dividing line is scale. The Central Pharmacy and Naoufel Amira speak of a limited number of imported products and of a few dinars or millimes; the UGTT says some products rose by more than 550 percent, and the circular covers around 300 medicines according to Réalités and Kapitalis, not a handful. The same spread runs through the coverage: the TAP copy published by La Presse and African Manager describes the circular as twelve medicines with small increases, which does not sit with the other accounts of the same document. The second split is over who carries the cost now: patients through the price, or the state through a reform nobody has yet decided.
What nobody is saying
None of the five statements we read says whether Cnam's reimbursement levels move with the new prices. The UGTT mentions holders of free and reduced-tariff care cards but gives neither a figure nor a mechanism, and the other four do not raise the question at all. For a patient with a chronic condition it is precisely that figure which decides what the circular costs him, and it appears in none of these statements.
Guiga notes that the circular is applied automatically and immediately by private pharmacies, which have no power to alter or refuse official prices. He points out that the price of some medicines actually fell, which separates him from those describing the decision as a straightforward increase. His objection is procedural: the timing was badly chosen, and the pharmacists' professional council was not consulted before the decision was taken.
Amira turns the question around: the revision is not enough, and still does not cover the Central Pharmacy's costs. He places it in a series of periodic adjustments, the last one a year ago and before that in 2018 and 2019, none of which reached the real cost of the medicines either. For several products, he says, the change amounts to a few dinars, and he attributes the outcry to poor knowledge of the file; restoring the establishment's financial balance is for him a precondition of pharmaceutical security.
”La révision et l'actualisation des prix des médicaments n'ont pas permis de couvrir les coûts supportés par la Pharmacie Centrale”The revision and updating of medicine prices have not made it possible to cover the costs borne by the Central Pharmacy
The seventeen deputies say they are concerned for patients on treatments that can be neither interrupted nor postponed. Their central point is that the medicines crisis cannot be settled by a price revision: they want structural reform of governance, financing, the position of the public establishments and the role of the social insurance funds, with transparency in how prices are set. They also ask for protection mechanisms for the chronically ill and low-income households, support for domestic pharmaceutical production, and consultation before major decisions.
”En Tunisie, le système pharmaceutique connaît de profondes difficultés liées à des dysfonctionnements qui se sont accumulés au fil des années. La Pharmacie centrale de Tunisie (PCT) ainsi que les différents établissements intervenant dans le secteur font face à des pressions financières et organisationnelles qui nécessitent une réforme”In Tunisia the pharmaceutical system is in deep difficulty, from malfunctions that have accumulated over the years. The Pharmacie centrale de Tunisie and the various establishments working in the sector face financial and organisational pressures that require reform
The UGTT department calls the increases excessive and unprecedented and says it is deeply concerned; on its account some products rose by more than 550 percent. It reads the decision as an attack on the constitutional right to health, and argues that the cost of the Central Pharmacy's and the health insurance fund Cnam's financial troubles is being shifted onto patients without any system reform being started. It singles out informal-sector workers with no social cover and holders of free or reduced-tariff care cards, and demands that the increases be reversed immediately and a genuine social dialogue opened.
”décisions unilatérales”unilateral decisions
The establishment says the revision concerns only a limited number of imported medicines whose prices had not been updated for several years, and that the rises stop at a few dinars or even a few millimes. The reason given is higher import costs and higher prices on world markets. Its stated purpose is to secure continued availability and avoid supply interruptions, which is to say that a more expensive medicine is better than no medicine at all.
”quelques dinars et même à quelques millimes”a few dinars and even a few millimes