These Minnesotans Are Going to Canada for Insulin

The Caravan to Canada raises awareness of life-saving insulin’s prohibitive pricing in the U.S.
From left: Two identical bottles of insulin (U.S. on the left, Canadian on the right); Nicole Smith-Holt (blue shirt) and Quinn Nystrom (black shirt) speak to the media before leaving Minnesota
Nicole Smith-Holt (blue shirt) and Quinn Nystrom (black shirt) speak to the media before leaving Minnesota

Courtesy Allison Nimlos

Standing in line at the Canadian border at just past midnight, we nervously giggled as the agent asked why we were heading to London, Ontario.

“To buy insulin,” replied Quinn Nystrom, my friend and the leader of the Caravan to Canada in late June, which would see a dozen individuals with Type 1 diabetes—plus some parents—purchase insulin over the counter at a fraction of what it costs in the United States. Nystrom, a former city councilperson in Baxter, has been self-employed since 2017 and also faces the high cost of insulin.

The Canadian Border Services agent looked up and asked where we were coming from. “Minnesota,” Nystrom replied. The Border Patrol agent, like many hearing about our 817-mile road trip through four states for the first time, looked confused. He probably wondered if we knew how to read a map.

But we weren’t going to London just to buy insulin. A much faster way to do that from the Twin Cities, involving much less sleep deprivation, is to drive five hours north to Fort Frances, Ontario—just across the border from International Falls. (A Caravan to Canada led by Nystrom  made that trek with a camera crew in May.)

We were going to London to send a message, to prove a point, to highlight an injustice. It wasn’t about scoring cheap insulin. It was about telling the story of millions of Americans struggling to pay for life-saving insulin, and about sharing the story of Frederick Banting, who, while living in London in 1920, had a dream that inspired the discovery of insulin. Banting later sold his Nobel Prize-winning patent to the University of Toronto for only $1—because he wanted insulin to be accessible to everyone. Nearly 100 years later, it still isn’t.

So how did a group of road-weary Minnesotans find themselves crossing the border at midnight? In 2017, Nicole Smith-Holt, a mother of four, discovered her 26-year-old son, Alec, had died from diabetic ketoacidosis. The cause? Rationing his insulin. Once Alec had aged off of his mother’s insurance, he couldn’t afford a $450 monthly premium and a $7,600 deductible. So he decided to pay for insulin over the counter, which cost $1,300 a month. With that amount beyond his reach, he decided to buy less until he could afford more.

Alec died three days before payday.

From left: Two identical bottles of insulin (U.S. on the left, Canadian on the right)
From left: Two identical bottles of insulin (U.S. on the left, Canadian on the right)

Courtesy Allison Nimlos

In the U.S., the average retail cost of a bottle of insulin is $300. In Canada, the same insulin costs $30.

While I stood outside the Canadian pharmacy on a Saturday afternoon, it felt surreal holding my bottle of insulin from the U.S. alongside the insulin I had just purchased. Same drug, same manufacturer, very different price tag.

After visiting the pharmacy, we stopped at the Banting House. It was a pilgrimage to honor the memory of the man who saved the lives of millions, including mine. Yet Alec died, and so many others are still dying or very sick.

Many concerned friends have asked if buying insulin in Canada is legal. A personal, prescribed supply of insulin? Yes. When we reached Port Huron, Michigan, on Sunday morning, we informed U.S. Border Patrol we had purchased insulin, and were armed and ready with prescriptions. Border Patrol was far more concerned with a cameraman who had not properly declared his camera in Canada. No one even looked at the insulin.

Caravan to Canada is not a solution—not by a long shot (pardon the syringe pun). But it is raising awareness. In late July, Vermont senator Bernie Sanders, a candidate in the 2020 U.S. presidential race, showed his support by taking part in a Canada insulin trip, as well.

In Minnesota, we came close to passing legislation to support emergency insulin access, named in honor of Alec. Governor Walz voiced his support, but at the 11th hour, it failed. Meanwhile, national agencies have rallied behind the safe importation of foreign drugs—with strings attached. Within the past month, three Minnesota insurance companies have decided to cut or cap co-pays for insulin, including Medica, UCare, and Blue Cross and Blue Shield of Minnesota—so long as patients are fully insured.

Insulin is the only medication a person with Type 1 diabetes can take to stay alive. And yet, one in four Americans ration insulin because of cost. We will continue pressing state legislators to make insulin more affordable and increase emergency access. Our lives literally depend on it.

Learn more about Caravan to Canada and how to help at t1international.com/MN

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Allison Nimlos
Allison Nimlos has lived with Type 1 diabetes for 25 years and began writing about the disease when she was only 15 years old. Her work has been featured in Better Homes and Gardens’ Diabetic Living, Diabetes Self-Management magazine, and the American Diabetes Association’s Diabetes Forecast. When she’s not advocating for affordable insulin (p. 20), she works as a family therapist in private practice in Roseville and spends time with her husband and 2-year-old son.