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Nicole Smith-Holt's son Alec, 26, died in 2017 of diabetic ketoacidosis after he was unable to afford a US$1,300 bill for insulin and diabetes supplies.Leila Navidi/Minneapolis Star Tribune

Kristen Hoatson is planning to board a chartered bus in Minneapolis on Friday for a cross-border shopping excursion that she hopes will draw attention to a crisis in the United States.

Ms. Hoatson, whose 11-year-old son, Sam, has Type 1 diabetes, is part of a caravan of American parents and patients travelling to Canada this weekend to buy cheap insulin in London, Ont., the birthplace of a drug that keeps millions of people alive and well on both sides of border.

“I think it really should be a human right for insulin to be affordable,” Ms. Hoatson said, “and it’s just not affordable in the United States.”

Take the bill for Sam’s fast-acting insulin. In January of this year, Ms. Hoatson paid US$357.70 for five pen cartridges of NovoLog, a bill that would have been US$824.79 if not for the private insurance her husband has through his job as a software developer.

The same amount of the Canadian equivalent, NovoRapid, would have cost $61.23 in Canadian dollars before the pharmacy markup, according to the Ontario government’s online drug benefit list.

Insulin prices, which can be as much as 10 times higher in the United States than Canada, have become a flash point in the battle over skyrocketing prescription-drug prices in the United States.

Against that backdrop, some Americans are looking to Canada – both as a source of cheaper insulin for purchase and as an example of how Washington could tamp down exorbitant drug prices.

The average U.S. sticker price of insulin nearly tripled between 2003 and 2013, according to the American Diabetes Association. The Health Care Cost Institute, a research agency funded by four U.S. insurance companies, found a rapid increase in health spending by patients with Type 1 diabetes between 2012 and 2016, most of it driven by a doubling of the list price of insulin over that period.

Canada has a federal regulator, the Patented Medicine Prices Review Board, which sets ceiling prices for brand-name drugs, and a federal-provincial-territorial alliance that negotiates discounted prices for branded and generic medicines.

Canada still has some of the highest list prices for prescription drugs in the world, and Diabetes Canada estimates that Type 1 diabetics in this country pay, on average, anywhere from $1,100 to $4,900 out of pocket annually for their insulin and supplies.

But Canada’s drug prices are dramatically lower than those in the United States.

“There’s no reason that a vial [of insulin] should be 10 times the price in America,” said Quinn Nystrom, a 33-year-old professional speaker and advocate with Type 1 diabetes who is helping to organize this weekend’s caravan. "America has gotten this really wrong and shame on America.”

Ms. Nystrom is organizing the caravan in co-operation with T1International, an advocacy organization for patients with Type 1 diabetes. She expects 18 people to ride the bus they’ve rented for their journey through Wisconsin, Illinois, Michigan and Ontario, with others travelling by car to join the group at its final destination in London on Saturday.

Between 35 and 45 people are expected for the group’s news conference at Banting House, a small museum commemorating Frederick Banting who discovered insulin, Ms. Nystrom said.

They are planning to visit five different pharmacies in London, where they have placed preorders for insulin, which is generally available without a prescription in Canada.

Among the riders on the chartered bus will be Nicole Smith-Holt, a Minneapolis mother whose son, Alec, 26, died in 2017 of diabetic ketoacidosis after he was unable to afford a US$1,300 bill for insulin and diabetes supplies. His body was found in his apartment, three days before his next pay cheque was due.

Ms. Smith-Holt drove with Ms. Nystrom and a smaller group to Fort Frances, Ont., in May to buy a single, symbolic vial of insulin. “I felt really angry that I could actually go five hours away and buy this life force for a 10th of the price," she said. "It would have kept Alec alive if I had known that this was an option.”

Although Americans have been crossing the border into Canada to buy prescription medications for two decades, the media attention directed at Ms. Smith-Holt, Ms. Nystrom and their fellow insulin shoppers has reignited fears that U.S. buyers could deplete Canadian supplies.

So far, that has not happened in the case of insulin, according to both Diabetes Canada and the Canadian Pharmacists Association (CPhA.)

Of greater concern to the latter group are laws passed by at least four U.S. states that would, theoretically, allow the bulk importation of Canadian prescription drugs. Those laws are meaningless without a federal waiver, which U.S. President Donald Trump has signalled a willingness to grant.

But pharmacist Barry Power, senior director of digital content at the CPhA, said it is not at all clear that multinational pharmaceutical companies would allow their U.S. profits to be undercut by their own Canadian subsidiaries.

“At the moment, there are a lot of things that we see as potential risks," he said. “But fortunately, so far, we haven’t seen anything come to [pass.]”

In the meantime, the risk of Americans with diabetes struggling to afford their insulin continues. Ms. Smith-Holt has already given her symbolic vial of Canadian insulin away to another patient in need.

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