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Free medicine distribution reduces health care costs and promotes health equity, study finds

[May 28, 2023: Staff Writer, The Brighter Side of News]

Health care costs continue to rise, posing significant challenges for individuals, healthcare systems, and economies. (CREDIT: Creative Commons)

Health care costs continue to rise, posing significant challenges for individuals, healthcare systems, and economies. Few interventions have proven successful in reducing these costs while simultaneously improving patient outcomes. Health inequities resulting from avoidable disparities, including income, racism, and discrimination, contribute substantially to health spending through poor outcomes among disadvantaged individuals.

To address these issues, better access to basic necessities and healthcare, particularly preventive care, is crucial. The quintuple aim of healthcare aims to reduce costs, improve outcomes, enhance patients' and clinicians' experiences, and promote health equity.


One significant factor influencing health outcomes and costs is cost-related nonadherence to medications. This occurs when individuals cannot afford their prescribed medications and therefore do not take them as instructed, leading to poor health outcomes.

Cost-related nonadherence is more prevalent among those with low incomes. The CLEAN Meds (Carefully Selected and Easily Accessible at No Charge Medications) trial was conducted in Ontario, Canada, to assess the impact of free distribution of essential medicines on individuals experiencing cost-related nonadherence.


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The trial, which initially spanned 24 months but was extended to 36 months, aimed to evaluate the effects of free medicine distribution on medication adherence, healthcare costs, and health outcomes. This article presents a secondary analysis of the CLEAN Meds trial, specifically focusing on the 36-month results of free medicine distribution and its impact on health care costs and encounters among primary care patients with cost-related nonadherence.

The CLEAN Meds trial was a parallel, two-arm, individually randomized clinical trial conducted in nine primary care sites across Ontario, Canada. Eligible participants were adult primary care patients (≥18 years old) who reported cost-related nonadherence in the 12 months prior to study participation. The trial enrolled a total of 786 participants between June 2016 and April 2017, with 382 patients assigned to the free medicine distribution group and 365 patients to the usual access group.


During the trial, participants in the free medicine distribution group received free access to 128 essential medications. These medicines were either mailed to participants or dispensed at the point of care for time-sensitive medications. Controlled substances and non-essential medications were not included in the intervention. Participants in the usual access group obtained their medications through regular means, including out-of-pocket payments, public insurance, or private insurance.

Visual Abstract. Effect of Free Medicine Distribution on Health Care Costs Over 3 Years. (CREDIT: JAMA)

Health Outcomes

The primary outcome of the CLEAN Meds trial was adherence to appropriately prescribed medications, which was previously reported at 12 and 24 months. In this secondary analysis, the main focus was on total health care costs over the course of 36 months.


Health care costs were assessed from the governmental payer's perspective using administrative data from Ontario's single-payer health care system. The outcomes considered included costs of ambulatory visits with primary care and specialist physicians, other physician costs (laboratory testing, emergency department visits, hospitalizations, publicly funded medications, and home care), and the number of health care encounters.

Of the 786 participants randomized in the CLEAN Meds trial, 382 were included in the free distribution group and 365 in the usual access group for this analysis. The results showed that free medicine distribution was associated with a lower median total health care spending over the three-year period, amounting to a reduction of $1641. Furthermore, the intervention was linked to a lower number of participants with very high total health care costs.

Hospitalizations represented the most significant cost in both groups, but there was no statistically significant difference in the number of hospitalizations between the free distribution and usual access groups. Additionally, there was no significant reduction in primary care visits, specialist visits, or emergency department visits.

Secondary Analysis

This secondary analysis of the CLEAN Meds trial demonstrated that free medicine distribution to individuals facing cost-related nonadherence was associated with lower total health care costs over the three-year follow-up period. The results of this study build upon earlier reports of the trial, which showed improvements in medication adherence and health care expenses after 12 and 24 months.


The findings suggest that promoting health equity through improved medicine access can reduce overall health care costs, aligning with the goals of the quintuple aim in healthcare. By eliminating financial barriers to essential medications, free medicine distribution addresses health inequities associated with cost-related nonadherence, ultimately leading to improved patient outcomes and reduced costs.

The study's strengths lie in its randomized clinical trial design and the use of routinely collected administrative data for assessing health care costs. However, several limitations must be considered, including the inability to capture expenses related to care accessed outside of Ontario and the lack of consent from some participants for the use of health administrative data.

The CLEAN Meds trial's secondary analysis provides compelling evidence that free medicine distribution significantly reduces health care costs and promotes health equity among primary care patients experiencing cost-related nonadherence. By addressing the financial barriers to medication access, this intervention offers a potential solution to the challenges of rising health care costs while simultaneously improving patient outcomes.

The findings from this study contribute to the growing body of evidence supporting the implementation of strategies that enhance medication access and promote health equity. Policymakers and healthcare stakeholders should consider the adoption of similar interventions to improve patient experiences, reduce costs, and achieve better health outcomes for all individuals, particularly those facing economic challenges in accessing essential medications.


Ultimately, prioritizing pharmacoequity and ensuring fair access to high-quality medicines will be crucial for achieving the quintuple aim in healthcare.

For more science news stories check out our New Discoveries section at The Brighter Side of News.


Note: Materials provided above by The Brighter Side of News. Content may be edited for style and length.


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