In the most prosperous country in the world, there are people, neither rich nor poor, who meet in car parks to exchange insulin, an old medicine as vital to them as oxygen, but which is unaffordable in pharmacies.
On a chilly January morning in the suburbs of Minneapolis, Abigail Hansmeyer leaves her engine running when she gets out of her car, between a coffee shop and a supermarket, to hand a lady a paper bag containing seven injection pens and a bottle of insulin.
“Thank you very much, it’s been a roller coaster ride these past few days,” says the lady, Annette Gentile, 52, checking the marks and dosages.
Annette, the mother of a 17-year-old boy, is not a pauper: she has a monthly disability allowance of $1,200 and public health coverage. But the insurance does not cover medication. The contents of the bag, enough for a month, would cost her a thousand dollars at the pharmacy.
“I depend entirely on gifts to stay alive,” says Annette.
Her provider, who is unemployed, is also a type 1 diabetic. It’s an autoimmune disease that requires injecting insulin, for life, several times a day.
Abigail thus gives, receives and trades insulin in an informal network of dozens of diabetics who pass on numbers and contact each other on Facebook. Almost all of the medication comes from unused stocks of dead diabetics donated by their relatives.
For Donald Trump’s Democratic rivals, who are campaigning for the primaries starting Monday in Iowa, there are few scandals worse than the price of insulin, a symbol of the inequality of the health care system.
“We’re not poor,” says Abigail. Her husband is working and has started his own micro-business. The couple lives in a house, Abigail has her car, dogs, rabbits.
The husband’s employer does not subsidize medical coverage. Not poor enough to have public insurance, nor rich enough to buy insurance at the full rate, the couple gave up in January, praying that no big glitch would occur.
“All my adult life, I’ve been rationing insulin,” says Abigail, 29, in her heated living room.
A few years ago, when she received her insulin pump after a battle with her then insurance company, she says she cried with joy.
– The death of a son–
In Minneapolis, if Abigail’s a drug dealer, Nicole Smith-Holt’s a wholesaler. In her basement, she opens her second refrigerator and unveils dozens of boxes of insulin. With a stock of syringes, strips and glucose meters, she says it could be worth $50,000.
“It’s strictly illegal,” she says.
– Then why are you doing it?
– Because I save lives.”
She’d almost be smiling about it if it wasn’t tragic. “We don’t need another Alec,” she says.
Alec Raeshawn Smith, died at home June 27, 2017; her son.
“There wasn’t a drop of insulin left in his apartment,” says the mother of four, counting Alec.
Alec was on his mother’s insurance until the age of 26, as the Obamacare reform allowed. But with his small salary as a restaurant employee, he couldn’t afford insurance after his 26th birthday. His mother is convinced that he was unable to pay the $1,300 that the pharmacist asked for a few days before his death.
In the United States, diabetics have created a free black market in insulin…
Alec Raeshawn Smith died at home in 2017 at the age of 26 from a lack of insulin. His mother is convinced that he was unable to pay the bill at the pharmacy / AFP
He’ll have gone 27 days without insurance. Cause of death: diabetic ketoacidosis, due to a lack of insulin.
“Until my last breath, I will feel regret,” says Nicole. She was worried about Alec but didn’t want to smother him. “Maybe if I’d insisted, if I’d asked the right question…”
The death of her son, who was a father, turned her into an activist, one day on television, the other at the local elected officials or in front of the headquarters of a large laboratory. Local diabetics can contact her on Facebook, she answers very quickly.
– O Canada –
Further north, diabetics farther away from Nicole have access to suppliers on the right side of the law but on the wrong side of the border: Canadian pharmacies.
In the United States, diabetics have created a free black market for insulin.
Travis Paulson visits a pharmacy in Canada three or four times a year to buy insulin. It costs him about six times less than if he went to a U.S. pharmacy / AFP
Unlike the United States, Canada has a price cap on insulin. Every three or four months, alone or with others, Travis Paulson, 47, drives two hours from Eveleth to Fort Frances, Ontario, across the Rainy River, and buys his insulin without a prescription. Border officials never bother him as long as the doses don’t exceed three months.
His insurance is excellent for reimbursement of doctor’s visits but only covers 50% of the cost of the medication.
Travis shows two almost identical vials of the same insulin: NovoLog (US, $345, half of which he pays), and NovoRapid (Canada, about $25). The calculation is quick.
In the United States, diabetics have created a free black market in insulin.
Two vials containing the same insulin: NovoLog (USA, $345, half of which is paid for by the patient), and NovoRapid (Canada, about $25) / AFP
“If I had to go by canoe to get my insulin, I would, I refuse to pay what they ask,” says Travis.
“It’s pharmaceutical greed, that’s all.”
On his fridge, a Bernie Sanders sticker reminds him of the revolution promised by the socialist candidate, who intends to halve the price of drugs. But even that may not be enough to replace travel to Canada.