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The US healthcare system is the most expensive in the world; almost half of all Americans reportedly struggle to pay for health care. Pay or Die explores the crushing financial reality for millions of insulin dependent Americans living with diabetes, as pharmaceutical companies push the price of this life saving medication to exorbitant levels, making record breaking profits. This is only further bolstered by the government’s lack of regulation.  


Pay or Die voices the stories of families struggling to afford their life saving medications in one of the richest countries in the world: the United States. The film trails a distraught Minnesota family desperate for answers after their son Alec dies at the age of 26 from rationing his insulin only weeks after aging off his parents health insurance. In Oregon, a mother and daughter who both live with type one diabetes become homeless due to the exorbitant cost of their medication and are forced to join the plight of medical refugees who are leaving the US to source affordable medication in other countries. A newly diagnosed woman must rethink her future to factor in her new economic reality. This enraging and enlightening film lays bare the human cost of the United States’ insulin affordability crisis, and serves as a call to action against the medical-industrial complex that monetizes our bodies and lives. 

“Most of my adult life has been defined by one inescapable question: How can I make enough money to afford the insulin I need to stay alive?”   
- Scott Ruderman, director, Pay or Die 

“We made a pact that no other family will go through the pain that we’re going through. We’re trying to make a change, a difference in the system. I don’t want to hear anyone else suffer. I hear too many names along with [my son] Alec. Enough is enough.”  
- James Holt Jr., film participant, Pay or Die 


Rachael Dyer

Director and Producer

Rachael Dyer, an Australian native and Canadian citizen based in New York, is an award-winning producer and journalist whose career has taken her across the globe, featuring stories seen on Netflix, Apple TV+, Disney, HBO Max, Hulu, Peacock, Oxygen, Discovery ID, OWN: The Oprah Winfrey Network and BBC. Most recently, she was a senior producer on Hillary & Chelsea Clinton’s documentary series, GUTSY (2022) for Apple TV +, a 4 part series, KEEP THIS BETWEEN US (2022), for Disney’s Freeform channel and Hulu and a 90 minute special for Oxygen and Peacock titled; SHERI PAPINI: LIES, LIES AND MORE LIES (2022). Her previous credits can be found on Netflix’s hit series (UN)WELL (2020) and Quibi’s ANSWERED by Vox (2020). Prior to her work in documentary, she worked in the field covering breaking news stories for BBC, Australian networks 7, 9, and ABC, and Channel News Asia. Rachael was awarded the Southern California’s Journalist Award for best international feature, as well as a Clio Entertainment Grand winning entry for her work on THE GREATEST SHOWMAN LIVE - the world’s first live commercial for a theatrical release.

Scott Ruderman

Director and Producer


Scott Ruderman lives with type 1 diabetes, and is an award winning filmmaker and cinematographer whose work has been screened in film festivals around the world as well as on Netflix, BBC, HBO, A&E, Hulu, and Discovery +. Scott's documentary short, PIANO CRAFTMAN, premiered at Big Sky Documentary Festival and Mountain Film Festival, and won a best director award at Madrid Art Film Festival. Scott’s recent cinematography credits include ANDY WARHOL’S AMERICA (2022), and a BBC mini series, CHASING GHISLAINE (2021). His cinematography work can also be seen on HBO Max’s THE CRIME OF THE CENTURY(2021), Netflix’s (Un)WELL (2020), and Hulu’s TASTE THE NATION (2020), which was nominated for an IFP Gotham Award. Ruderman’s producing credits include UNANSWERED IVES, which was awarded the Czech Crystal at the 2019 Golden Prague International Film Festival, and WHITER SHADE OF TERROR, a film about the the global spread of anti-muslim rhetoric and an increasingly violent white supremacy movement. Most recently, Scott was a producer on the film ROCK CHICKS, an upcoming documentary that tells the stories of women in rock’n’roll. Ruderman holds a Master of Fine Arts degree in Social Documentary Film from the School of Visual Arts.