Year: 2023

Runtime: 90 minutes

Directors: Rachael Dyer and Scott Alexander Ruderman

By Joan Amenn

Nominated for a Grand Jury Award at this year’s SXSW, “Pay or Die” is a heartrending look at the cost of insulin and the emotional, physical and financial toll it has taken on citizens of the US. It is very important to note that the horrific scenarios shown in this film are unique to the US and are not similar to healthcare concerns in other countries. It is also important to note that the Biden Administration has proposed a federal budget that includes a $35 monthly cap on the cost of insulin for those who are insured and already has enacted this cap for those receiving Medicare.

The journey to these latest developments has been a grim battle for many families who have lost loved ones to diabetes who could not afford the cost of effective treatments. “Rationing” insulin, or attempting to stretch the supply one can pay for to meet the demands of their illness, has cost many their lives in this country. It can literally reach thousands of dollars monthly in not only insulin but other supplies such as needles and monitoring devices to keep diabetes in check. It’s no wonder then that many cross the Canadian border to stock up on medical supplies at a cost so low it actually is cheaper, including the airfare, than attempting to pay for the same materials at home.

“Pay or Die” has no problem calling out the three pharmaceutical companies that manufacture insulin in the US for being the cause of all this suffering. Specifically, Pharmacy Benefit Managers negotiate prices between the pharmaceuticals and consumers. In the process, “rebates” are often offered to suppliers to boost profits. For example, CVS Health runs the second largest PBM which hardly seems reassuring that they have consumers’ best interests in mind.

“… the simple and terrible truth is no parent should have to take on the role of hero while grieving. Indeed, no parent should have to grieve the loss of a child at all, especially due to the greed of large corporations.”

While “Pay or Die” seems a bit formulaic in telling the story of families who become advocates after the loss of a loved one, the simple and terrible truth is no parent should have to take on the role of hero while grieving. Indeed, no parent should have to grieve the loss of a child at all, especially due to the greed of large corporations. Some families cannot recover from the heartbreak of death, financial devastation and sheer emotional trauma, nor should they be judged for that. “Pay or Die” reminds us that our healthcare system is broken but in the light of COVID-19 few are not aware of this fact. Let’s not normalize devastated parents protesting, addressing their representatives and advocating for what should be basic human rights. Let’s fix the problem so no one else has to experience what the people in the this film have gone through.