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Pay or Die

1h 30m Documentary 2023

World Digital Premiere

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Audio Described version of this film is available by purchasing this version : Audio Described Version: Pay Or Die

Closed Captioning available in English You can select this option by clicking the ‘CC’ button in the bottom right of the player to turn on captions.

Pay or Die voices the stories of families struggling to afford their life saving medications in one of the richest countries in the world: the United States. The film trails a distraught Minnesota family desperate for answers after their son Alec dies at the age of 26 from rationing his insulin only weeks after aging off his parents health insurance. In Oregon, a mother and daughter who both live with type one diabetes become homeless due to the exorbitant cost of their medication and are forced to join the plight of medical refugees who are leaving the US to source affordable medication in other countries. A newly diagnosed woman must rethink her future to factor in her new economic reality. This enraging and enlightening film lays bare the human cost of the United States’ insulin affordability crisis, and serves as a call to action against the medical-industrial complex that monetizes our bodies and lives.

Nominated, SXSW Grand Jury Award - Documentary Feature, SXSW Film Festival 2023

“Most of my adult life has been defined by one inescapable question: How can I make enough money to afford the insulin I need to stay alive?”
- Scott Ruderman, director, Pay or Die

“We made a pact that no other family will go through the pain that we’re going through. We’re trying to make a change, a difference in the system. I don’t want to hear anyone else suffer. I hear too many names along with [my son] Alec. Enough is enough.” - James Holt Jr., film participant, Pay or Die

Content Advisory 15

We do not want the cost of entry to be a barrier for participation in the festival. If the price of buying a ticket to this film would prevent you from participating, please email the following address ( + you will receive an auto-reply email with a free ticket code. We have set aside a set # of tickets per film on a first come first-served basis. Once the free tickets are no longer available, the code will no longer work. For anyone that purchases a ticket, we appreciate your support. Your ticket purchase enables us to make tickets free for those who might otherwise be unable to watch. This also allows the festival to support the filmmakers for sharing their work in our festival and for the festival to cover the cost of hosting the films online.


Rachael Dyer


Rachael Dyer


Yael Melamede



Closed Captions [CC]



United States