Just after Emma Kleck turned 26, she started looking up flights to Canada.
Kleck, who has type 1 diabetes, knew she’d be paying a hefty sum each year for the test strips, body sensors, and insulin vials she needs to manage her disease once she switched from her parents’ insurance to the high-deductible plan her job offers. She was determined to see if she could find a cheaper option.
In the U.S., insulin costs have more than tripled in recent years. A single vial of Novo Nordisk’s Novolog, the insulin Kleck takes daily, costs roughly $300 per vial. Kleck uses a little over a vial per month.
Those rising prices have had disastrous, and sometimes deadly, impacts for people with type 1 diabetes, 1 in 4 of whom have reported they’ve rationed insulin to save money. It’s particularly hard for young people like Kleck who aren’t making as much money or offered as robust an insurance plan as older Americans. Alec Smith, a 26-year-old restaurant manager from Minnesota, died from rationing insulin less than one month after aging off of his mother’s insurance.
In Canada, however, insulin costs less than $50 per vial. And increasingly, people seeking cheaper insulin are flying north from all over the U.S. to stock up.
In December, Kleck booked the cheapest flight she could from her home in Santa Cruz, Calif., 1000 miles north to Vancouver. The Right Care Alliance, a Massachusetts-based advocacy group, supplied her with a list of reputable Canadian pharmacies that it keeps at the ready for those planning their own pilgrimage. She traveled with photographer Monique Jaques, who documented their trip.
Kleck’s trip underscores the lengths to which people with diabetes will go to save on this lifesaving drug. But it also highlights the toll diabetes itself takes on patients, costs aside. The mundane inconveniences of waiting in long lines, lugging heavy suitcases, and being stuck in an airplane seat can mean waves of blood sugar highs and lows that require constant vigilance.
That’s true for even Kleck, whose diabetes management is about as automated as it can be.
She has, mounted on her skin, a wireless glucose monitor that keeps a watchful eye on her blood sugar levels, along with another sensor that delivers her insulin through the skin without the need for constant injections. The two communicate via an app on her phone that the Food and Drug Administration hasn’t yet approved. If her monitor detects high blood sugar, her app will send a signal to her insulin pump, which will then automatically deliver her a specific amount of insulin — all without her intervention.
But Kleck needs to prepare for the worst: She carries a teal pouch emblazoned with “All My Diabetes Shit.” At last check, it included three back-up insulin pump patches, a handful of syringes, a vial of insulin, lip balm, a blood glucose meter, test strips, a lancing device, a packet of gooey electrolytes, a handful of used test strips — along with her car registration, her insurance card, and a credit card. Throughout the trip Kleck also kept close watch on a vial of glucagon, an emergency injection that first responders can use to revive patients who have a diabetic emergency like a seizure.
Then there’s the tattoo sprawled across her left forearm meant to alert first responders of her diabetes in the event she’s found unresponsive. On her 18th birthday, the tattoo replaced the medical alert bracelet her parents made her wear throughout her childhood.
Americans crossing into Canada for cheaper drugs isn’t altogether new. Droves of seniors made national news in the early 2000s when they organized busload after busload to Canada. Presidential hopeful Sen. Bernie Sanders (I-Vt.) rode along with activists with type 1 diabetes on a similar pilgrimage last year.
Sensing a business opportunity, pharmacies, like the one Kleck visited, have popped up along the Canadian border. They provide a safer alternative to online pharmacies, some of which have been plagued by counterfeit drugs.
But Kleck admits she was a bit skeptical when she pulled up to a dilapidated strip mall on the outskirts of Vancouver only to find a run-down pharmacy nestled between an adult shop, a fried chicken joint, and a marijuana dispensary.
When she finally got the nerve to walk in, she was greeted by an operation dedicated almost exclusively to serving the U.S. market. Packaging supplies and even dry ice, meant to keep insulin at a safe temperature while it travels through the mail, lined the walls.
She walked out of the pharmacy with 10 vials of Canada’s version of Novolog, named NovoRapid, at a cost of $459. The same insulin would have cost her $2,570 in the U.S., according to Kleck’s calculations.
It’s technically illegal to import unapproved drugs from Canada, but regulators typically don’t object to patients eager to save a few bucks while on vacation. FDA’s website states that it “typically does not object” to people importing less than a three-month supply of a drug for personal use.
The question she got, however, she was unprepared for: “How much cheaper was the insulin?” the guard inquired.
After a quick back and forth, they were free to go, insulin in hand.
Kleck’s insulin now sits in her refrigerator. Despite the literal highs and lows of living with type 1 diabetes, she knows she won’t have to worry about paying for her insulin — at least for the next 10 months.
When her stockpile runs out, she won’t be forking over $300 to her local Walgreens. Instead, she plans to test out her new favorite pharmacy’s mail-order service.
“It’s going to be so easy,” Kleck said.