Some statistics place global estimates of medication nonadherence between 40% and 60%. A major reason for this could be the prohibitive cost of life-saving medicines used to treat patients with conditions like HIV or cardiovascular disease. In this patient population, providing medication at no charge greatly improved treatment adherence, according to study results published in JAMA Internal Medicine.

Researchers in Canada conducted a randomized clinical trial that measured the effect of providing Canadian patients with free essential medicines. The trial, which lasted for 24 months, enrolled patients age ≥18 years who reported medication nonadherence in the previous year due to financial factors. Patients were placed into either an intervention group, which received free distribution of medicines, or a control group, which accessed their medications as usual. A list of 128 essential medicines was adapted from 2013 World Health Organization guidelines and the medicines were distributed to patients via the mail. Medicines that were commonly prescribed in the study included diabetes treatments, analgesics, vascular disease treatments, and asthma treatments. The control group accessed medicines as usual had out-of-pocket costs of approximately $800 annually.

Related Articles

As the researchers hypothesized, free distribution increased medicine adherence by 11.6%, with little indication of patient subgroup effects on the results (age, sex, etc.). Compared with the control group, patients who were part of the free distribution group also were more likely to receive a new prescription before the previous one had run out. They reported an improvement in care and that they were better able to afford necessities vs the group with usual medicine access. In addition, there was evidence to support that free distribution lowered systolic blood pressure and may have aided in better diabetes control. However, many in the free distribution group saw no improvements in secondary outcomes, reinforcing that cost is only one of several factors that contribute to medicine regimen adherence.

Continue Reading

Free distribution of essential medicines was shown to improve treatment adherence. Bettering access to essential medicines can improve quality of care and move toward achieving universal health coverage. The researchers hope that their results can inform policy changes moving forward.


Persaud N, Bedard M, Boozary AS, et al. Effect on treatment adherence of distributing essential medicines at no charge: The CLEAN Meds randomized clinical trial. JAMA Intern Med. Published online October 07, 2019. doi:10.1001/jamainternmed.2019.4472