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Recently, the IRCC made it a requirement to have an upfront medical exam for applicants submitting their application after Express Entry ITA!
Upfront Immigration Medical Examination (IME) for Express Entry
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Upfront Immigration Medical Exam, IME Clinic Inc.
New Express Entry applicants are no longer required to undergo a first medical examination.
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IRCC Removes Upfront Medical Exams for Express Entry
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Changes in Express Entry: No Upfront Medical Examination Required
New Express Entry Applicants No Longer Need Upfront Medical Exam
No Upfront Medical Exam Required for Express Entry