Olivia is a soft-spoken mother of two, who immigrated to Canada from Uganda in 2007. She now lives in Toronto’s St. James Town neighbourhood and works as a personal support worker. Recently, Olivia came down with a nasty infection that caused her to be hospitalized and lose over 20 pounds. It was when she was discharged and faced with the costs of her medications, however, that the tough decisions began.

As a part-time worker without benefits, Olivia had to choose between paying for medication or paying for food. “I’ve been working for almost nine years now, but we don’t have benefits yet,” she says. “They keep saying it’s for full-time staff, although I work full time hours.” According to the Wellesley Institute, a third of working Canadians do not receive employer-provided health benefits. For part-time workers like Olivia, this number swells to 73 percent.

Due to the need to pay for prescription drugs out-of-pocket, many Canadians skip or reduce dosages, delay refilling prescriptions, or don’t fill prescriptions at all — a phenomenon known as “cost-related non-adherence.” The most recently available data show that cost-related non-adherence affects 8.2 percent of patients, a disproportionate number of whom are low-income women and those who already have poor health. People who find themselves in such situations often face the difficult decision of whether to forego other basic needs in order to deal with their illnesses.

Olivia is part of the CLEAN Meds study at St. Michael’s Hospital, a two-year experiment testing the effects of providing patients with free and convenient access to a carefully selected set of medications. It’s a randomized controlled trial in which half of the participants are put into the group that gets free medications, while the other half are left with their usual access to medications. Unfortunately for Olivia, she was assigned to the control group.