SXSW: The High Cost of Insulin in ‘Pay or Die’

By Abe Friedtanzer

It should surprise virtually no one that there are tremendous issues with the healthcare system in the United States today, and that pharmaceutical and insurance companies are a big part of those problems. The award-winning limited series Dopesick showed just how detrimental the prescription of excessively powerful drugs can be. A new documentary premiering at SXSW, Pay or Die, looks at another side of the coin: the exorbitant cost of medication necessary to a person’s survival and the dire consequences of falling short…

Pay or Die focuses on type 1 diabetics and the insulin they need in order to stay alive, which comes with a hefty price tag. Three families share their stories, among the “nearly two million Americans being held for ransom,” as the film puts it, forced to pay high prices for something that is absolutely vital to their very existence. In one of the most potent and upsetting focuses, two parents, James and Nicole, advocate tirelessly for the passage of the Alec Smith Emergency Insulin Act, a Minnesota bill named after their late son, who died as a result of rationing his insulin.   

A crucial piece of any nonfiction film is to examine how we got here, and this film does so from the beginning. It charts a one thousand percent price increase in insulin since its development, and looks at that astronomical cost within the United States as compared with other countries. One pharmacist in Canada regularly receives visitors who have found that the cost of insulin there is significantly less expensive - even with an international flight added in. Yet that isn’t a feasible solution for everyone, and leaving behind a broken system in search of success elsewhere is hardly the solution this film champions. 

This is an important film, but also one that will serve to add stress to the lives of those already less than optimistic about their own medical prospects. When one diabetic travels through an airport with a pump during the COVID-19 pandemic, she counts the number of people she sees without a mask on until she just has to stop, too overwhelmed by the increasing total. Such moments convey the seriousness and inescapability of this situation to those who could never understand what it is like to be immunocompromised and to have to divert a substantial portion of their paychecks to this life-saving insulin. Pay or Die presents the high stakes and, like any change-driven documentary, directs audiences to ways to get involved in order to make what it outlines and explores a concept of the past. B+

Pay or Die makes its world premiere in the Documentary Feature Competition at the SXSW Film Festival.

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