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SXSW First Look: Sky High Cost Of Insulin Threatens Lives In Competition Documentary ‘Pay Or Die’

'Pay or Die'

EXCLUSIVE: A wrenching documentary premiering at SXSW points to a terrible dilemma facing a huge number of people in this country: “Today, nearly two million Americans are being held for ransom. Without insulin, they’ll be dead in days.”

Pay or Die, directed by Rachael Dyer and Scott Alexander Ruderman, “follows three families on the receiving end of these ransom notes, revealing the harrowing reality of life with chronic illness in the richest country in the world.” The exclusive clip above offers your first look at the film, which is playing in Documentary Feature Competition. 

“From a mother and daughter struggling to rebuild their lives after losing their home when they had to spend their rent money on insulin,” a description of the film says, “to a young adult diagnosed with type 1 diabetes during the Covid-19 pandemic, to a Minnesota family thrust into the national spotlight when their 26-year-old son dies from rationing his insulin, Pay or Die lays bare the human cost of America’s insulin affordability crisis.”

“The astronomical price of insulin hurts American families,” a Rand Corporation headlined a study it published in 2021. Rand found the average price of insulin in the United States ran almost $99 a vial, compared to $7 in Australia, $7.52 in the U.K., and $12 in our neighbor to the north, Canada.

“The average price in America, across all types of insulin, was more than ten times higher than the average for all of the other countries combined,” the Rand study reported. “The differences were especially stark when the researchers looked at rapid-acting insulin, which makes up about a third of the U.S. market. Its average price in other countries was just over $8. In America, it was $119.”

In the clip above, a young woman tries to master giving herself insulin injections without losing precious fractions of the costly substance. “The last time we did it, you wasted a lot of insulin,” her partner comments anxiously. “And this time it was just as [bad]. You’re not looking at what the costs are going to be long term.”

Taylor Jane Stimmler, who's had type 1 diabetes since she was a teenager, displays her insulin and needles used for injection, on March 2, 2023 in New York City.
Taylor Jane Stimmler, who’s had type 1 diabetes since she was a teenager, displays her insulin and needles used for injection, on March 2, 2023 in New York City. Photo Illustration by Spencer Platt/Getty Images

In an announcement earlier this month, pharmaceutical giant Eli Lilly said it would cap insulin costs for users at $35 a month out of pocket (in line with a provision of the Inflation Reduction Act signed into law in January that imposes a $35 a month out of pocket cost on insulin for seniors on Medicare). But Eli Lilly is only one of three big providers of insulin in the United States – the other two are Novo Nordisk and Sanofi. And as for the Inflation Reduction Act provision, it doesn’t cover people with private insurance or the uninsured.

Sarah Silverman is seen at 'Jimmy Kimmel Live' on October 13, 2022 in Los Angeles, California.
Sarah Silverman is seen at ‘Jimmy Kimmel Live’ on October 13, 2022 in Los Angeles, California. Photo by RB/Bauer-Griffin/GC Images

Pay or Die holds its premiere on Saturday at the Alamo Lamar, with additional screenings set for the same theater complex on March 13 and 16. Sarah Silverman is among the executive producers of the film. In a video shared with Deadline, she said, “The cost of insulin has skyrocketed in recent years and it’s made it difficult for people to be able to afford it. It is especially challenging for our 26-year-olds who are aging off of their parents’ insurance. As a result, many people are forced to ration their insulin, meaning they have to take less than they need in order to live, and it’s putting their lives at risk.”

In addition to Silverman, the executive producers of Pay or Die are Amy Zvi, Russell Long, Douglas Choi, Martina Bassenger, Marci Wiseman, Dawn Bonder, Sarah Lucas, Zak Kilberg, Trish Adlesic, and Lauran Bromley. The film is produced by Rachael Dyer, Scott Alexander Ruderman, and Yael Melamede, and directed by Dyer and Ruderman. Ruderman is the cinematographer; the editors are Will Rogers and Tony Shimin. Music is by T. Griffin. 

Pay or Die is an acquisition title at SXSW. Watch the exclusive clip above.

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