When people get prescription drugs for free, their lives improve, their health improves and health systems save money, a new study found.
In the study, published May 21 in PLOS Medicine, researchers looked at 786 people who told their health care provider that they hadn't taken their medication in the last year because they couldn't afford to fill the prescription. When 395 of them were given free medications for two years, they went to the hospital less — and Canada's health system saved money.
"The amount is surprising — $1,000 per patient per year," said lead author Nav Persaud, the Canada research chair in health justice and a physician at St. Michael's Hospital, part of Unity Health Toronto. The intervention got people to take their prescriptions more: 38.7% of people who got free drugs were taking them regularly after two years, while only 28.6% of people who were left with the status quo were taking their drugs.
The study has broad implications, Persaud said: He and his co-authors didn't just look at people with chronic conditions, but at anyone who reported they were recently unable to afford a medication.
"What we wanted to do was measure the effect of a general policy," said Persaud, who is also an associate professor at the University of Toronto. Although Canada's public health care system pays for inpatient and outpatient treatment, for many people it does not fully cover outpatient prescriptions, including drugs necessary for basic survival such as insulin and blood pressure medication. Among countries with universal health care, Canada is the only one without universal pharmaceutical care.
"There's not a good reason," Persaud said, noting that advocates have been pushing to include drugs in the public system for decades — and meeting resistance. And while there is prior research about the positive effects of accessible prescriptions, this is the first clinical trial to show that adding free prescriptions to the system would not just help patients' health; it could also save the Canadian government a huge amount of money.
Patients in both groups were commonly prescribed drugs such as analgesics, diabetes medications, drugs to reduce stomach acid production and hypertension treatments, as well as inhalers for asthma and chronic obstructive pulmonary disease. The biggest costs and savings were in hospital admissions, including intensive care unit stays. Persaud said there were people in the study who couldn't afford insulin; they would eventually be admitted to the hospital, they would receive insulin to take home and when that ran out, they'd be back in the hospital.
The researchers did not find significant differences in the subpopulations of patients who needed drugs for diabetes, cholesterol or blood pressure management — the numbers didn't show that their disease was better controlled when their drugs were free. However, that was likely because of data gaps: The study relied on patients' regular clinicians to test people, and important data was missing in the second year of the study. The missing data almost certainly would have showed that their disease was better controlled, Persaud said, since the researchers did see improvement at the one-year mark when there was more data from clinicians.
The intervention apparently made a difference in patients' ability to survive in other ways, too. In a survey at the end of a two-year period, 86.4% of people with free medications said they could make ends meet, while only 28.6% of people in the control group said they could make ends meet, a startling difference of 57.8 percentage points.
"In some cases the value of the medications was fairly small — it would work out to something like $30 per month for people," Persaud said. The survey revealed some of the potential ripple effects of helping people access prescription medication: In some cases, small amounts of money could make a huge difference for a low-income person, Persaud said.
Persaud is hopeful that Canada and other nations might reform their health systems — he spoke about his findings before the U.S. Senate Subcommittee on Primary Health and Retirement Security in March. But in the meantime, the state of affairs is dispiriting, he said.
"I wish I lived in a world where it wasn't necessary to do a study like this," Persaud said. "I wish it wasn't even possible to do a study like this — in order to do the study, we needed to recruit people who didn't take their medication because they couldn't afford it. … It's sad, a tragedy, maybe a human rights violation that we were able to do the study."
The paper, "Adherence at 2 years with distribution of essential medicines at no charge: The CLEAN Meds randomized clinical trial," published May 21 in PLOS Medicine, was authored by Nav Persaud, Tara Gomes, Stephen W. Hwang, Andrew D. Pinto and Andreas Laupacis, University of Toronto and St. Michael's Hospital, Unity Health Toronto; Michael Bedard, Northern Ontario School of Medicine; Andrew Boozary, Harvard University; Richard H. Glazier, University of Toronto, St. Michael's Hospital, Unity Health Toronto and Institute for Clinical Evaluative Sciences; Peter Juni and Steven G. Morgan, University of Toronto; Michael R. Law, University of British Columbia; Muhammad Mamdani, St. Michael's Hospital, Unity Health Toronto, University of Toronto, and St. Michael's Hospital and Vector Institute; Braden Manns, University of Calgary; Danielle Martin, University of Toronto, Women's College Hospital; Paul Oh, University of Toronto and Toronto Rehabilitation Institute; Baiju R. Shah, University of Toronto, Institute for Clinical Evaluative Sciences; Frank Sullivan, North York General Hospital, University of St. Andrews; Norman Umali, St. Michaels Hospital, Unity Health Toronto; Kevin E. Thorpe, University of Toronto, St. Michael's Hospital; and Karen Tu, University of Toronto, North York General Hospital.