Documentary Feature Competition presented by ACE91

Pay Or Die

Check out the Conference Session with Pay or Die's Filmmaker Scott Alexander Ruderman, film subject Nicole Smith-Holt, and Mayo Clinic Research Physician Dr. S. Vincent Rajkumar:

Today, nearly 2 million Americans are being held for ransom. Without insulin, they’ll be dead in days. "Pay or Die" follows 3 families on the receiving end of these ransom notes, revealing the harrowing reality of life with chronic illness in the richest country in the world. From a mother-and-daughter struggling to rebuild their lives after losing their home when they had to spend their rent money on insulin, to a young adult diagnosed with type 1 diabetes during the COVID-19 pandemic, to a Minnesota family thrust into the national spotlight when their 26-year-old son dies from rationing his insulin, "Pay or Die" lays bare the human cost of America’s insulin affordability crisis.

Programming descriptions are generated by participants and do not necessarily reflect the opinions of SXSW.

photo of Rachael Dyer
photo of Scott Alexander Ruderman



Rachael Dyer, Scott Alexander Ruderman

Executive Producer:

Sarah Silverman, Amy Zvi, Russell Long, Douglas Choi, Martina Bassenger, Marci Wiseman, Dawn Bonder, Sarah Lucas, Zak Kilberg, Trish Adlesic, Lauran Bromley


Rachael Dyer, Scott Alexander Ruderman, Yael Melamede


Scott Alexander Ruderman


Will Rogers, Toby Shimin

Sound Designer:

Tom Efinger, Abigail Savage, Jeff Seelye


T. Griffin

Additional Credits:

Social Impact Strategist: Caitlin Boyle, Social Impact Producer: Red Owl Partners , Development Producer : Alex Swerdloff


Public Film Contact:

Scott Alexander Ruderman

Publicity Contact:

Madison Tobin

Sales Agent:

Travis Tamerro - United Talent Agency

Primary Access
Platinum Badge
Film & TV Badge
Secondary Access
Music Badge
Interactive Badge
Film & TV Festival Wristband
Premiere Status:
Screening Category:
90 mins