Study: People Are More Likely to Take Their Medication if It’s Free

Financial barriers can keep people from taking their medication as prescribed. What would happen in a world in which essential medicine was free?

"For many people, it's either paying your rent, buying groceries, or buying your medication," Leonard Valentino, MD, the chief executive officer of the National Hemophilia Foundation, tells Verywell. "The provision of free medication will eliminate that cost issue."

To test this theory, researchers at St. Michael's Hospital of Unity Health Toronto in Canada sought to examine whether free medications would support patients in taking them as prescribed. They split 786 patients based in Ontario into two groups for the two-year study.

One group received medication by mail for free, and those in the second group received medication as they would normally. Participants in this study were 18 years or older and had self-reported not adhering to their medication as prescribed in the last 12 months.

The trial included 128 essential medications, including antibiotics, pain relievers, antipsychotics, and medications used to treat HIV/AIDS.

The researchers found that adherence to all prescribed medicines was 35% higher in the group who received their prescriptions for free compared to those who didn't. 

"These findings could help inform policy changes in countries planning to implement universal healthcare that includes access to medicines," the researchers wrote.

The study was published in the PLOS Medicine journal in late May.

"This study just told us what we already know, which is providing free medications or at reduced costs will definitely...help patient outcomes," Vino K. Palli, MD, MPH, emergency room physician and CEO of MiDoctor Urgent Care, tells Verywell. Palli was not involved with the study.

Universal Healthcare Doesn't Always Include Free Drugs

While Canada has universal healthcare, the cost of medication may still pose a barrier to care for Canadians.

"Universal health care or health care, in general, [includes] medical expenses, physicians, nurses, physiotherapy, mental health, etc.," Valentino says. "The drugs are usually paid for on a separate plan."

But even without a program for free drugs, non-generic medication, and treatment for diabetes treatment like insulin is often cheaper in Canada compared to the United States. A 2020 report from the RAND Corporation found that the cost of insulin in the U.S. is more than six times the cost in Canada. However, generic medications were more expensive in Canada compared to the U.S.

Financial Barriers to Accessing Medications

According to a 2019 poll conducted by the Kaiser Family Foundation, nearly one in four Americans say it's difficult to afford their medicines. And 35% of people who make below $40,000 expressed difficulty affording their prescriptions.

Other groups that reported difficulty included:

• 58% of people who have a drug that costs $100 or more a month
• 23% of seniors
• 35% of people who take four drugs a month or more

People with chronic health conditions and older adults on average also pay more out of pocket every year for medications than people who do not have chronic health conditions or are younger.

According to Georgetown University's Health Policy Institute, people between the ages of 65 to 79 pay $456 out-of-pocket annually for healthcare costs, and people who are 80 or older pay around $530 out-of-pocket for prescribed medications annually. People with diabetes, heart disease, or hypertension all pay over $500 annually on prescribed medications.

"Forcing people to spend money on something sometimes means that you're assuming that they have the money and that if you give it to them for free, they'll abuse it, and that's just not necessarily the case," Talya Miron-shatz, PhD, an expert in medical decision-making and a visiting researcher at the Winton Centre for Risk and Evidence Communication at Cambridge University, tells Verywell.

There's a Cost if Patients Don't Take Their Medications

Providing medications free of charge is not a new policy. Governments have provided free medications for decades to control infectious diseases like tuberculosis. The free distribution of these medications can be both cost-effective for communities and help curb the spread of disease.

"The reason they do it is not just because of the high cost, but [tuberculosis is] a highly infectious disease that spreads very rapidly," Palli says.

According to Palli, HIV is another infectious disease that, if left untreated, can burden the healthcare system. "It's not just the patient is going to get full-blown HIV/AIDS, that patient is going to spread to multiple partners, so the cost is enormous of health care burden is very high," Palli says.

Beyond a burden on health care, there are also financial incentives for encouraging people to take their prescriptions in the United States. A 2019 study published in the journal Medical Care found that not properly taking medication for diabetes, heart failure, hyperlipidemia, and hypertension costs Medicare billions annually.

"If the 25% of beneficiaries with hypertension who were nonadherent became adherent, Medicare could save $13.7 billion annually, with over 100,000 emergency department visits and 7 million inpatient hospital days that could be averted," the researchers wrote.

Other Systemic Issues Still Need to Be Addressed

While reducing the cost of medications or giving them to patients for free could remove some barriers, it will not fix healthcare inequalities for everyone.

Valentino says that in order for people to safely take their medication, they need a safe, sterile place to store it, as well as access to basic needs.

"I had a family that lived in a car, and they were using an injectable medication," Valentino says. "They had nowhere to wash their hands to be able to inject this medication."

Valentino stresses the importance of addressing systemic issues as part of any plan for universal health care.

"Universal health care with universal pharmacare benefits is really a step in the right direction, but again, there has to be a focus on addressing the social determinants of health," he says.