When the four-car caravan set out for Ontario, it was part protest, part press conference, and part act of survival. For one mother, it was also an act of remembrance.

Insulin in Canada sells for a fraction — roughly one-tenth — of what it costs in the U.S., and these Minnesotans were determined to see whether they could get a better deal by jumping in a car and crossing the border. So, that’s what they did. On Saturday, six advocates, three reporters, two photographers, and a pair of supportive parents piled into four cars, all emblazoned with hand-painted slogans of “#Insulin4All,” and made the pilgrimage from the Twin Cities to Fort Frances.

The group also had a point to make to Washington politicians who are currently struggling to stem ever-escalating insulin prices.

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“Can you explain to me why I would stay in the U.S. and continue to be price-gouged for $320 a vial when I can drive five hours and get it for $30?” Quinn Nystrom, a caravan participant, told STAT. “The only difference between us and Canada is politicians here in America have not created any solutions to lower the price of insulin. … The federal government, they talk about all these laws, but they can’t get them passed.”

The group is loosely affiliated with the diabetes advocacy organization T1International, an advocacy organization with chapters in 28 states, according to its website. An Arizona chapter of the group has recently made a trip to Mexico for the same purpose, and the group’s Michigan chapter intends to make a similar trek to Canada Thursday, according to Twitter.

The idea was first floated in a Facebook group by Lija Greenseid, a Minnesota native who has a daughter with type 1 diabetes and has made a habit of traveling around the world buying insulin. The pitch took some in the group by surprise — multiple caravan participants told STAT they had no idea they could make that journey. But whether they knew it or not, they were carrying on a rich tradition in America’s northern states, following in the footsteps of a great many patients who trek to Canada to buy cheaper drugs. Former Minnesota Sen. Mark Dayton, a Democrat, donated his entire congressional salary in the early 2000s to bankroll pilgrimages for this very purpose.

Carvan to Canada Pharmacy
Advocates display the insulin they purchased at a Shoppers pharmacy in Ontario, Canada. Rachel Nystrom

The trip itself went off without a hitch. The group hit a brief stumble at the border, not because they were openly importing insulin, but because a journalist accompanying them had filmed the border crossing. And after a five-hour journey, the group walked into a Shoppers pharmacy, and walked out minutes later with arms full of insulin.

“I’m sure it was [worth] $10,000 list price in the U.S., that we ended up getting for like $1,000,” Greenseid told STAT.

Most of the caravan purchased Novo Nordisk’s NovoLog, which is known in Canada as NovoRapid, for roughly $30 a pop. The same drug retails for $289.36 in the U.S., according to a Novo Nordisk spokesperson.

“There was this incredible sense of freedom and relief,” said Nystrom, who is enrolled in a high-deductible health insurance plan and typically racks up more than $7,000 in out-of-pocket medical expenses each year. “Just the thought that I don’t have to keep going to a pharmacy and being price-gouged and putting that on my credit card and feeling like I won’t keep going into debt.”

The high prices have pushed the 33-year-old further than a debt scare, too. She’s had to ask her parents for help, considered applying for a second job at Starbucks for the company’s health insurance, and even contemplated marrying a friend for his health coverage.

“That’s how bad it is in America: a medical marriage,” Nystrom remarked. “I would really love to marry somebody for love.”

For Nicole Smith-Holt, the motivation was different. She doesn’t have diabetes, but she purchased a vial of Sanofi’s Lantus nonetheless.

It was the same insulin Smith-Holt’s son Alec took before he aged off her insurance and quietly began rationing his insulin, only to die less than one month later.

Crossing the border was always a thought for Smith-Holt, but she was under the impression it was illegal.

“It made me so angry that this was not a publicly known option at the time,” Smith-Holt told STAT. “Two years ago I could have made this trip and Alec would still be here.”

The one vial, which cost Smith-Holt roughly $60, now sits in her refrigerator. She is determined to keep that tiny vial properly stored, so she can gift it to another person with diabetes struggling to afford their insulin.

If it expires, she will add it to Alec’s memorial.

This isn’t the last time these Minnesotans are likely to cross the border on their search for cheaper insulin.

They’ve already made public pleas to Minnesota Sens. Amy Klobuchar and Tina Smith, former Sen. Al Franken, and even former CMS administrator and Minnesota native Andy Slavitt — all Democrats — to sponsor a bus, a la Sen. Dayton’s pilgrimages nearly 20 years ago.

And they’re not waiting for the senatorial sponsorship to come through: Nystrom is already in talks with a Michigan chapter of T1International to organize a caravan this summer to London, Ontario.

The city holds a special significance: On that trip, the caravan will make the trek to the home of Frederick Banting, the man who, on Oct. 31, 1920, awoke from his bed on the second floor of that very house and jotted down the idea that eventually led him to discover insulin.

The same man who sold the drug’s patent for $1, with the hopes it would never be out of reach for those who need it.

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  • Walmart still has two types of insulin that are $25 per vial. They have the short-acting and long-acting but even the long-acting seem to be shorter acting than the newer insulins.

    • Yes, Walmart sells Regular (a short-ish acting insulin) and NPH, which is a long-ish acting insulin. The total active time for Regular is 4-6 hours. It takes 45-60 minutes to begin working. So meals need to be planned out and timed. No extra roll or deciding you’re full before you’ve finished your plate. NPH has an active time of 8-12 hours and it peaks much more seriously at around hour 6. The cycles of R and NPH require snacking and eating at precisely the same times each day. They carry a much higher risk of both hypoglycemia and hyperglycemia. $25 Walmart insulin can save your life, it is not providing as good quality of life as the newer analog insulin’s which have a rapid active time or an ultra long, smooth active time. Keep in mind, when the new analog insulin’s were introduced in the late 90s, they were $21. Making exclusive profit which funded R&D and lots of marketing and sales perks for doctors. It was profitable at $21. Taking US inflation into account that price would now be $34. It is $325 instead. The list prices are ludicrously high.

  • Kudos to the pilgrims to Canada. Very cool!

    However, it’s worth noting that if the FDA used its enforcement discretion, under Section 804J of the Food, Drug and Cosmetic Act, to permit people to order insulin by mail from licensed pharmacies in Canada by using overnight mail services like Fed Ex, they would not have to travel. They should not have to travel!

    Gabriel Levitt
    Prescription Justice

  • Kind of tired of repeating myself.
    There are millions of people needing insulin. Instead of organizing buses, they should constitute a noprofit and outsource the production of insulin to specialized companies, and pay it at production cost. Insulin itself is not covered by patent.

  • This is ridiculous, it’s been this way since well before the 90’s.I was taking a drug that req’d a scrip in the US, I was in Mexico on vacation.
    I noticed it on the SHELF (OTC) for $2.50,here I had to have a scrip and it cost me $35.00.That was in 1989!.

    • You just proved the Govt is doing nothing. The cost of these drugs are getting outrageous. Drug companies are price gouging. If they can sell it so cheap all over the world, they can do the same here in the US but it will take legislation, which hasn’t been done.

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