CLEAN Meds: Carefully seLected and Easy Accessible at No charge Medications

In Progress

Access to Medications

Can providing free essential medicines help people take their medication consistently – and ultimately improve their health?

Canada is the only high-income country where health-care services are publicly insured but medications are not. Research shows that 2.4 million people in Canada don’t take the drugs they need because they can’t afford them. Every year, hundreds of Canadians die because they cannot afford their medication. And across the country, at least a million Canadians have to choose between food and basic essentials to afford to fill their prescriptions.

This randomized-controlled trial is the first in Canada to test the effects of giving people access to essential medicines for free, and to measure the impact of medication costs on health outcomes.

What we’ve learned

Our results have shown that if everyone in Canada could access essential medications free of charge, it would not only improve the country’s health overall, but would save the health-care system billions of dollars.

People who received drugs free were 44% more likely to take their medications as prescribed. Health outcomes such as blood pressure improved.

Eliminating out-of-pocket medication costs was also associated with lower reduced total health spending by a median of $1641 and a mean of $4465 over 3 years.

“This is no longer a question of whether free distribution of medicines can improve health outcomes,” said Dr. Nav Persaud, Principal Investigator. “It is a question of whether governments will act.”

About the study

This is an open-label, parallel two-arm, superiority, individually randomised controlled trial that was codesigned by a community guidance panel.

The study included 786 people across nine primary care sites in Ontario who reported cost-related non-adherence to medications. Most of the study participants were recruited from St. Michael’s Department of Family and Community Medicine.

Participants in the intervention arm of the study were randomly allocated to receive free distributions of essential medicines, while others in the control arm of the study had only their usual access to medication. We compared the health of those given free medications with those who had to pay for them.

The list of 128 essential medicines made available in the study was adapted from the WHO Model List of Essential Medicines and based on Canadian clinical practice guidelines, suggestions from clinicians and patients, prescribing volumes and evidence syntheses. The medicines in the study included treatments for acute conditions, such as antibiotics and pain relievers, as well as chronic conditions, such as antipsychotics and HIV-AIDS medications.

We will use the findings to influence public policy and support the scale-up of similar interventions in other cities. The ultimate goal is universal, public coverage of essential medicines.

The CLEAN Meds study was one of two lists of essential medicines included in a Health Canada report to the Canadian Drug Agency. The report was developed as a starting point for determining which drugs should be funded for all Canadians.

Learn more at

Access to Medications

Dr. Nav Persaud

Dr. Nav Persaud has dedicated his career to narrowing the health gap between the highest and lowest wealth brackets, and to ensuring that everyone in Canada can afford the medication that they need. Dr. Persaud is a Canada Research Chair in Health Justice.


  • Dr. Michael Bedard (Northern Ontario School of Medicine)
  • Dr. Andrew Boozary (Harvard School of Public Health)
  • Dr. Peter Jüni (St. Michaels Hospital)
  • Dr. Andreas Laupacis (University of Toronto)
  • Dr. Michael Law (University of British Columbia)
  • Dr. Muhammad Mamdani (St. Michael's Hospital)
  • Dr. Braden Manns (University of Calgary)
  • Dr. Danielle Martin (Women’s College Hospital)
  • Dr. Steven Morgan (The University of British Columbia)
  • Dr. Paul Oh (University Health Network)
  • Dr. Baiju Shah (Institute for Clinical Evaluative Sciences)
  • Dr. Frank Sullivan (University of St. Andrews)
  • Dr. Kevin E. Thorpe (University of Toronto)
  • Dr. Karen Tu (University of Toronto)


  • Canadian Institutes for Health Research
  • Ontario SPOR (Strategy for Patient Oriented Research) Support Unit
  • St. Michael’s Hospital Foundation

Contact Info

Dr. Nav Persaud

Principal Investigator