Quinn Nystrom is carrying the thing that saves her life in two large brown bags. The 32-year-old from Minnesota is one of a busload of diabetics who have made the journey from the US to a pharmacy in Canada to stock up on vital supplies of the drug insulin. Only minutes’ drive from the border, they are paying a tenth of what they would at home.
Outside the pharmacy in Windsor, Ontario, a crowd has gathered to show solidarity. Nystrom, who is wearing a grey T-shirt bearing the words “Insulin is a human right”, launches into an impromptu speech. The diabetes activist seethes as she tells them how, as a consequence of soaring drug prices, one in four American diabetics now rations their use of insulin.
“We know that our purchase today in this Canadian pharmacy was not a charity. Right?” she tells the onlookers. “We know that [the drugmakers] made a profit, though far less profit than they do from Americans. But what they’re doing to Americans is price-gouging us and they are holding us hostage. And people are dying. People are being forced to go to emergency rooms. People are having their legs amputated. They are going blind. They are having heart disease, liver damage. When does it stop?”
Inside the pharmacy, a whitehaired man in a suit tells people he wants to make it stop. Bernie Sanders, US senator from Vermont and Democratic presidential candidate, has helped organise the trip with the activist group Insulin4all to highlight patients’ suffering.
He listens intently as a mother tells him how she shares one child’s insulin between her three diabetic kids (type 1 diabetes has a genetic element). Another woman tells him how she spent her twenties in and out of intensive care because of complications from rationing insulin.
The sky-high price of many drugs — and the increasing contribution expected even from insured patients — is a potent subject ahead of the 2020 US election. Sixty-two per cent of voters say healthcare is the most or the second most important issue for the future of America.
President Donald Trump knows this: at the last election, he pledged to bring down the cost of prescriptions. His opponents, too, see an opportunity to propose more ambitious plans as, three years into his term, Trump has not yet helped patients at the pharmacy counter.
Increasingly, politicians on both sides of the aisle are looking for solutions — to Canada and beyond. Patient “caravans” such as Insulin4all’s — the medical equivalent of a booze cruise — are currently allowed to bring back a three-month supply for personal use. But the president and a number of other candidates have proposed legalising mass importation from Canada, while some are also looking to peg US prices to those in other developed countries.
Sanders’s hair dances in the breeze as he begins his address to the gathering outside the pharmacy. He is adamant he would go further than stopgap measures that rely on pricing policies in other countries. If he becomes president, he would instruct his attorney-general to use antitrust laws to break up industry monopolies and end price fixing.
“Three huge drug companies, which made $14.5bn in profit last year, control 90 per cent of the insulin market,” he says, referring to insulin makers Eli Lilly, Sanofi and Novo Nordisk. “And as I think the patients here will tell you, it is an amazing coincidence that, year after year, prices go up and up and up at the same level for the same companies. So what you do is you throw these people in jail if they engage in price fixing.”
Drugmakers — often forgotten in countries where medicines are cheap — loom large in the lives of Americans like those on the trip. Kathy Segos from Indiana describes how their decisions have dictated her life. The insulin she buys for her son Hunter costs her $1,200 a month (until the family reach their “deductible”, an annual limit on out-of-pocket costs, after which the insurance pays the rest).
It is her household’s singlebiggest expense — prioritised above everything else. She says she has sat in the dark when her electricity was cut off because she chose to pay for insulin to keep Hunter alive.
When Hunter discovered this, he tried to ration his insulin, affecting his performance at college. “It was pretty scary to know that your son felt that he was a burden to you,” says Segos, tears welling. “I will sacrifice everything I have to keep my child alive. Yet my son, through no fault of his own, his pancreas doesn’t work.”
How politicians attempt to limit drug prices will dictate the way Segos — and many others — vote next year. “I grew up very conservative, a very straight-ticket GOP Republican girl. But when Hunter was diagnosed, my husband and I both changed our views a little bit,” she says. “I vote strictly based on healthcare: how are you going to fix this problem? Because he’s gonna be 23 next month, and he’s got his whole life ahead of him.”
Almost a quarter of American patients have trouble affording their prescriptions, according to a survey by health research institute the Kaiser Family Foundation. Some 43 per cent of US adults under 65 are on “high-deductible” plans, so their insurance only kicks in after they have spent thousands of dollars.
Drug prices have soared: America spent $334bn on prescription drugs in 2017, up 41 per cent from 10 years ago, according to National Health Expenditure data. The opaque US health system makes it hard to draw drug-by-drug comparisons with prices abroad. But the OECD estimates that the US spent about 47 per cent more per capita on prescription drugs than Canada in 2018 and 160 per cent more than the UK.
