“Pay or Die” comes to us from executive producer Sarah Silverman (yes, that Sarah Silverman) and directors Rachael Dyer and Scott Alexander Ruderman, with the latter having a personal stake in the film’s subject matter. Ruderman was diagnosed with type 1 diabetes when he was just 19 years old, forcing him to micromanage his diet along with doses of insulin, which means every single day’s activities must be coordinated in order to ensure that his blood sugar doesn’t get too high. Though Ruderman was able to afford his insulin while on his parents’ insurance plan, after hitting the age of 26, he was forced to confront the rising costs of insulin and the distressing danger of living with type 1 diabetes in America.

Around the rest of the globe, the cost of insulin is a mere fraction of what it costs in the United States. The average price of insulin in America is roughly “more than ten times higher than the average for all of the other countries combined,” according to Rand Corporation. A vial of insulin can cost upwards of $300 in the United States. The result is a population afraid that their paycheck won’t be able to afford them the insulin they need to live another day. People of every age have died far sooner than they should have simply because pharmaceutical companies like Eli Lilly, Novo Nordisk, and Sanofi have made it impossible to afford. This comes after, as the documentary explains, the creators of insulin sold their patent for the drug for just $1, simply because they didn’t think they should profit from it. But of course, this is America, where someone is always looking to make a buck off someone else’s suffering. 

Even though Eli Lilly has recently taken steps to drastically lower the price of insulin recently, as the directors responded in a statement provided to the press, “…it is important to remember that the key issue is not about these companies voluntarily slashing prices; it’s about changing laws, so the insulin manufacturers do not have the ability to raise the prices again.”