For Lija Greenseid, the math was simple.
Drive a few hours to pay $56 for a box of Humalog insulin pens for her young daughter with type 1 diabetes or pay as much as $230 at home.
The decision, in fact, was a no-brainer for Greenseid and a group of diabetes advocates and patients who made the trek from Minnesota to Canada to buy insulin in early May.
Unlike many people with employer-sponsored health insurance or other discounted plans, Greenseid and her husband are both professional consultants.
That meant they had to buy insurance through MNsure, Minnesota’s health insurance marketplace created through the Affordable Care Act, and choosing a high-deductible plan they could afford.
Their plan left them paying “very close to retail price” for insulin, Greenseid told Healthline, coming to as much as $700 per month.
All told, the group that trekked to Canada spent $1,265 on insulin, which had a retail price of over $12,400 in the United States.
That’s a savings of more than $11,000, Greenseid noted.
Traveling to Canada, Mexico, or even farther afield to obtain cheaper drugs and medical care has become something of an American tradition.
“The idea is nothing new. Paul Wellstone used to bus people to Canada and back for prescription drug runs in the 1990s,” Travis Paulson, managing director of Northern Minnesota Advocacy Group and a caravan organizer, told Healthline.
Greenseid is also no stranger to “insulin tourism.”
She’s purchased cheaper insulin, usually without a prescription, in no less than five countries — Greece, Italy, Germany, and Israel in addition to Canada — and always at a discount compared to the price she would have paid in the United States.
Paulson, who has type 1 diabetes and lives an hour-and-a-half from the Canadian border, said he’s been getting his insulin there well before this headline-making caravan launched in May.
“The fact is that I cannot wait for Congress to fix a broken system,” he said. “I need insulin like people need air to breathe. Without insulin, I would die within 24 hours.”
The caravan wasn’t just practical for its members. They posted their journey on social media with the intent to be seen and heard.
“I think all of us in the caravan felt a bit of protest in our hearts,” Paulson said. “How and why should we continue to pay 10 times the price other countries pay for life-sustaining insulin?”
Insulin has also become an avatar of the larger fight against rising prescription drug costs in general with both Democrat and Republican politicians proposing solutions, and drug companies themselves offering to self-regulate.
For instance, Democrats have proposed a plan to lower drug prices by tying prescription drug costs to the median drug costs in five other countries.
Meanwhile, President Trump has vocally backed Florida’s plan to reimport drugs from Canada, putting him potentially at odds with Alex Azar, the Health and Human Service Secretary he appointed who once described drug importation as a “gimmick,” Politico reported.
But those approaches are a problem, said Sally C. Pipes, president and chief executive officer as well as a fellow in healthcare policy at the Pacific Research Institute, a California-based think tank that “champions freedom, opportunity, and personal responsibility… by advancing free-market policy solutions.”
For one thing, there’s a safety issue. Pipes pointed out that CanadaDrugs.com was recently fined $34 million for importing counterfeit and unapproved drugs into the United States — not just from Canada but all over the world.
Then, there’s some practical facts.
“Canada cannot be the drugstore for the United States,” Pipes told Healthline. “Canada has 37 million people, fewer than in the state of California.”
With insulin prices drawing the attention of Congress and the president, companies such as Sanofi and Cigna Express Scripts have expanded their discount programs to offer cheaper insulin to more consumers for a flat monthly fee as low as $25 per month.
But those programs don’t put Greenseid’s mind at ease.
“There’s always going to be people who fall through the cracks if we don’t have some sort of more systemic safety net or price cap,” she said.
Pipes, for her part, favors “free-market solutions” such as speeding up the approval of new insulins that allow older insulins to become cheap generics.
However, insulin may be something of a cash crop for drug companies, with a history of price fixing from providers going back to at least 1941.
And more recently, a lawsuit filed by 44 states this month accuses leading drug manufacturers of engaging in a price-fixing scheme for generic drugs to increase their prices by more than 1,000 percent, the New York Times reported.
Meanwhile, diabetes advocates and caravan members promoted and organized under the motto #Insulin4All to push for greater access to the drug.
Whatever the solution is, it’s clear that the status quo isn’t working, Greenseid said.
She related the experience of making 15 phone calls over an 11-day period to get her daughter’s prescription refilled on their new insurance plan.
“When you’re the parent of a child with a life-threatening condition like type 1 diabetes, there’s such a feeling of anxiety all the time in the United States that, you know — how am I going to make sure I get her what she needs this month?” she said.
Greenseid also worries about her daughter’s future if things don’t change.
“What if the Affordable Care Act goes away tomorrow and she’s not going to be insurable?” she said. “Or will she always be shackled to some employment because of her chronic condition and the need for health coverage through an employer?”
“The lack of freedom that we have [with] this great amount of anxiety and economic burden and health burden is just not what we as Americans deserve,” she said.