Pay or Die – Co-directors Scott Alexander Ruderman and Rachael Dyer

In their illuminating and infuriating documentary film, PAY OR DIE, filmmakers Scott Ruderman and Rachael Dyer, cinematically ask the question, how and why are nearly 2 million type 1 diabetic Americans are being held for ransom? Without insulin, they would all 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. Co-directors Scott Alexander Ruderman and Rachael Dyer join us to talk about their own personal connection to the scourge of diabetes, the misconceptions about the disease and the people who are infected by it and the film’s premiere and Grand Jury Prize nomination at the 2023 SXSW Film Festival. 


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“Most of my adult life has been defined by one inescapable question: How can I make enough money as a filmmaker to afford the insulin I need to stay alive?” – Scott Alexander Ruderm

About the filmmaker – Director / Producer / Cinematographer Scott Alexander Ruderman lives with type 1 diabetes and is an award-winning filmmaker 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 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. 

About the filmmaker – 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 Quibis 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. 



100% on RottenTomatoes

“Bluntly if appropriately titled, Pay or Die serves as an infuriating reminder of the economic and social injustice permeating our system…” – Frank Scheck, Hollywood Reporter

“The film is as straightforward as it gets and often raw in quality or form despite some nice but sporadic use of animation. However, the subject and people involved need no artifice to convince or connect with viewers.” – Hanna B, Film Threat

“Filmmakers Rachael Dyer and Scott Alexander Ruderman make an emotional plea to stop the exorbitant prices of insulin for those afflicted with diabetes.” – Ethan Anderton, Slashfilm

“Pay or Die profiles three families impacted by type 1 diabetes, chronicling the healthcare crisis that faces three million Americans dependent on insulin, the sixth most expensive liquid in the world, costing $113,000 per gallon.” – Diane Carson,