Summary: This important Canadian study found that making essential medicines free – removing financial barriers – raises adherence, lowers medical costs, and generally raises patient perceptions of well-being, including overall health.
Adherence at 2 years with distribution of essential medicines at no charge: The CLEAN Meds randomized clinical trial.
May 21, 2021
By N Persaud et al
From Author Summary:
What did the researchers do and find?
- We conducted a randomized controlled trial of free essential medicines distribution in 786 people who reported trouble affording medicines in a setting where healthcare services are publicly funded.
- Free medicine distribution improved adherence to medicines appropriately prescribed after 2 years (absolute risk difference, 10.1%; 95% confidence interval (CI) 3.3 to 16.9, p = 0.004).
- Free distribution had inconsistent effects on surrogate health outcomes over 2 years and lowered total healthcare costs by a median of CAN$1,117 (95% CI CAN$445 to CAN$1,778, p = 0.006).
What do these findings mean?
- Distributing a comprehensive set of essential medicines at no charge to primary care patients improved medicine adherence and reduced healthcare costs.
Comment by: David Himmelstein and Steffie Woolhandler
Medicines work only if you take them. As every doctor knows, many patients don’t take what we prescribe. High costs are only one reason – a lesson sadly reinforced by experience with COVID-19 vaccinations – but they’re a big one.
Canada’s single payer health insurance system pays all doctor and hospital costs, but many Canadians lack coverage for prescription medications – a shortcoming that progressive activists and politicians have been pushing to fix.
This trial carried out in Ontario shows that full coverage for prescription medications would substantially increase the proportion of patients who take what we prescribe – increase “adherence” in doctor-speak. Surprisingly, total health care costs were lower among patients in the free medication group – by 38%. As the authors note: “Healthcare spending in all categories except home care costs were lower in the free distribution group, and hospitalizations accounted for the largest share of spending.”
Moreover, for 10 of the 14 survey-based measures of patient-oriented outcomes the free med group did better, with 2 showing a non-significant trend to improvement with free meds and 2 showing no trend. “The 3 largest effects . . . were in the ability to ‘make ends meet’ or afford basic necessities (57.8% absolute increase; 95% CI 50.5% to 65.1%), care quality (31.5% absolute increase; 95% CI 23.7% to 39.2%), and overall health (30.9% absolute increase; 95% CI 22.8% to 39.0%).”
Canada needs to move ahead with universal drug coverage, which is known as Pharmacare in that nation. In the U.S. we need Pharmacare, and the rest of the coverage that Canadians already enjoy.