Pay or Die

Wednesday, November 1 - Wednesday, November 8, 2023

In-person Q&As with directors Rachael Dyer and Scott Ruderman and film subjects Nicole Smith-Holt and James Holt on Wednesday, November 1 at 7:30 p.m. moderated by Frances Underhill (Senior Manager, Programming, Production and Outreach at Human Rights Watch Film Festival) and Academy Award nominee Beth Levison on Thursday, November 2 at 7:30 p.m.


The US healthcare system is the most expensive in the world; almost half of all Americans reportedly struggle to pay for health care. Pay or Die explores the crushing financial reality for millions of insulin dependent Americans living with diabetes, as pharmaceutical companies push the price of this life saving medication to exorbitant levels, making record breaking profits. This is only further bolstered by the government’s lack of regulation.. 

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.

“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

Previously screened as part of the Human Rights Watch Film Festival 2023.

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

  • Country USA
  • Running Time 90 minutes
  • Distributor Paramount +
  • Director Rachael Dyer, Scott Alexander Ruderman
  • Accessibility T-Coil, Assistive Listening

IFC Center does not generally provide advisories about subject matter or potentially triggering content in films, as sensitivities vary from person to person. In addition to the synopses, trailers and other links on our website, further information about content and age-appropriateness for specific films can be found on Common Sense Media, IMDb and DoesTheDogDie.com as well as through general internet searches.