Giving blood pressure and other essential medicines free improves health, trial shows

Giving people free medications helps makes them healthier, a Canadian randomized trial proves.

More people who received drugs free took the medications as prescribed

Beulah Jarvis called not being able to afford an asthma inhaler 'the albatross around my neck.' Being able to take her medications regularly improved her health. (Craig Chivers/CBC)

When people who couldn't afford essential medications to lower blood pressure or control diabetes received the treatments free, their health improved, according to a randomized trial that could inform Canada's pharmacare discussion.

Medicines are not universally publicly funded in Canada the way hospitalization and physician care are.

Dr. Nav Persaud of St. Michael's Hospital in Toronto and his co-authors followed 395 people in Toronto and the Ontario communities of Blind River and Manitoulin Island assigned to receive free medications and 391 others to usual care for a year.

"We partly did this study because we were so concerned about what was happening to our patients here who couldn't afford medications," Persaud said.  "We hope that by the time this study ends there'll be a public policy change that will mean everyone in Canada who needs access to medications will have it."

In Monday's issue of the journal JAMA Internal Medicine, Persaud and his team reported giving medications free resulted in 11.6 per cent better adherence to treatment.

The researchers monitored patients taking medications for high blood pressure and blood glucose in diabetes, as well as antiretrovirals for HIV, antipsychotics, antibiotics and analgesics.

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More people who received drugs free took the essential medications as prescribed (151 of 395 or 38.2 per cent) compared with those in the group with usual access to medicine (104 of 391 or 26.6 per cent).

Those who had their antihypertensive medications covered had reduced systolic blood pressure. 

Diabetes control also showed clinical improvements in reducing complications although the differences weren't statistically significant, Persaud said.

Free statins to improve low-density lipoprotein cholesterol levels were not affected.

Matthew Herder, director of the Health Law Institute at Dalhousie University in Halifax, studies health care policy. He wasn't involved in the new study.

Better adherence

Herder said about one in four Canadian households say they have trouble accessing medicines they need, and this trial shows the importance of easing that financial barrier and adding pharmacare to the health-care system.

"This study provides clear evidence that adherence improves for those who don't have to pay for their own medicines," Herder said.

The idea for the study was born out of frustration when doctors discovered their patients couldn't afford the medicine they were prescribed. (Craig Chivers/CBC)

Beulah Jarvis of Toronto was enrolled in the study after she had trouble affording her $180 asthma inhaler.

"That was the albatross around my neck for the longest time because not having this made it very hard to breathe at night and sleeping was horrible," Jarvis, 51, recalled.

The self-employed woman said she'd skip doses, stretching the monthly inhaler to last two months.

"It was really stressful and there were a lot of things that I couldn't buy foodwise," Jarvis said.

When she took her medications regularly, her health improved. Jarvis said she's also now better able to afford what she needs.

The research was supported by the Canadian Institutes of Health Research, the Ontario SPOR Support Unit that is supported by the Canadian Institutes of Health Research and the Ontario government, the Canada Research Chairs program, and the St. Michael's Hospital Foundation.

With files from CBC's Kas Roussy and Melanie Glanz