FORT FRANCES, Ontario — After driving the 197 miles from their home in Maple Grove, Minn., and staying the night in the Eveleth Super 8 Motel, and then driving another 107 miles to this town just across the border from International Falls, it took Tony Bolin and Kari Holvik-Bolin no more than six minutes to complete the transaction for which they came.

“It’s no different from saying, ‘I want a prescription,’” Bolin related. “Then they grab it and check and scan it, and you’re done.”

Photo gallery: Going north to save on life-saving drugs

Why travel 300 miles to visit the Shoppers Drug Mart in this small (population 7,739) border town?

Because the savings made it well worth their trouble, said the couple, both in their 30s. Holvik-Bolin, who has type 1 diabetes, had just purchased the 20 vials of insulin she will need to keep her alive for the rest of the year. Taking into account the Canadian exchange rate, she had just saved about $6,000 U.S.

Tony and Kari had become part of a continuing phenomenon of people in the U.S., frustrated that the same insulin costs many times more in their country than in Canada, crossing the border to purchase a supply of the drug.

Travis Paulson of Eveleth holds insulin he had just purchased at the Fort Francis Shoppers Drug Mart for less than $700 American. In America the purchase would have cost $6,400, he said. (Steve Kuchera / skuchera@duluthnews.com)
Travis Paulson of Eveleth holds insulin he had just purchased at the Fort Francis Shoppers Drug Mart for less than $700 American. In America the purchase would have cost $6,400, he said. (Steve Kuchera / skuchera@duluthnews.com)

They gathered with a few others on Sept. 21 in Eveleth, where they met with Travis Paulson, an Eveleth man with type 1 diabetes who has become a crusader on the cost-of-insulin issue. Paulson, 46, has been leading such trips for five or six years, he said; this was his third of 2019.

It was also his last of the year, and it might be his last ever.

“If … an insulin bill (in Congress) comes through next year, that changes the game,” Paulson said. “Yeah, I would be done.”

In the statehouse

There’s certainly interest at the Minnesota capitol in getting something done, even talk of a special session on the issue yet this year. This past Wednesday, the Minnesota House Health and Human Services Division conducted a hearing on the high cost of insulin and prescription drugs.

The week before, Minnesota Senate Republicans unveiled a proposal to require pharmaceutical companies to provide diabetics with insulin for free if they were not already on a public health care assistance program and if their family income is less than 400 percent of the federal poverty level. That’s around $50,000 for a single person and around $100,000 for a family of four.

But Paulson is unimpressed by the plan. It requires people to visit the doctor to get insulin, he said, at an additional expense. It doesn’t apply to people who are on Medicare. And for people just above the income cut-offs, the cost of insulin still could be devastating.

But fundamentally, the GOP plan doesn’t get at the heart of the matter, Paulson argues.

“I want to see just a plan that is good for everybody,” he said. “No restrictions. Just lower the price of insulin at its source, which is the pharmacy, Big Pharma. … There’s no reason at all, besides greed, that it’s going to be $350 a bottle here, and $25 in Canada.”

Kari Holvik-Bolin shows her insulin pump to Terrence Brehmer, who uses a different model, while waiting to buy insulin in Fort Frances recently. In the background Holvik-Bolin’s husband Tony Bolin wears a shirt the couple designed and made. The Holvik-Bolins came from Maple Grove, Minn., while the Brehmers came from Milwaukee, Wis., to purchase insulin in Canada. (Steve Kuchera / skuchera@duluthnews.com)
Kari Holvik-Bolin shows her insulin pump to Terrence Brehmer, who uses a different model, while waiting to buy insulin in Fort Frances recently. In the background Holvik-Bolin’s husband Tony Bolin wears a shirt the couple designed and made. The Holvik-Bolins came from Maple Grove, Minn., while the Brehmers came from Milwaukee, Wis., to purchase insulin in Canada. (Steve Kuchera / skuchera@duluthnews.com)

$25 at Walmart

Whenever this issue is written about, an objection is raised: You can buy insulin for $25 per vial in the U.S., at Walmart and other retailers. But that form of insulin was the best available three decades ago, Paulson and others traveling to Canada said. The up-to-date version is much less likely to result in premature death and complications.

“It barely worked for me when I was diagnosed 26 years ago,” Holvik-Bolin said. “I’m in much better control using this insulin versus the cheap Walmart (kind).”

Would it keep you alive? she was asked.

“Maybe, but it wouldn’t be a very good quality of life,” Holvik-Bolin said.

Added Bolin: “And is it worth the risk?”

Paulson said his body has become resistant to the older form of insulin, so taking it doesn’t help him. Taking the old form also requires that food be eaten every four hours.

But all of that misses the point, he said in a follow-up email: All forms of insulin, even the most advanced, cost $25 to $30 per vial in Canada.

Travis Paulson of Eveleth drives past U.S. Customs in International Falls on his way to buy insulin in Canada recently. Paulson has led several caravans of Americans going to Canada to buy lower-priced drugs. This caravan brought participants from as far away as Milwaukee. (Steve Kuchera / skuchera@duluthnews.com)
Travis Paulson of Eveleth drives past U.S. Customs in International Falls on his way to buy insulin in Canada recently. Paulson has led several caravans of Americans going to Canada to buy lower-priced drugs. This caravan brought participants from as far away as Milwaukee. (Steve Kuchera / skuchera@duluthnews.com)

560 miles

Whatever happens in Minnesota won’t affect one couple who joined the caravan. Terrence and Sheila Brehmer met with the group in Eveleth after driving from their home in Milwaukee — 560 miles from Fort Frances.

Terrence Brehmer, 67, developed type 1 diabetes in 2000 after having a gall bladder operation that resulted two months later in pancreatitis. The Brehmers learned about the caravan from a “PBS Newshour” segment that featured Minnesota diabetes activist Quinn Nystrom. Terrence contacted Nystrom, who called him back later to tell him about the trip Paulson was organizing.

Under his employer’s health plan when he was working, Terrence Brehmer paid $600 per year for 40 to 45 vials of insulin, he said.

Now, he’s on Medicare and has supplemental insurance through a group plan that covers 80% of his insulin cost. The last time out, Brehmer said, he paid $654 out of pocket for 10 vials — a three-month supply — still hundreds of dollars more than they would pay in Canada.

The idea of people from the U.S. traveling across an international border to buy medicine has attracted worldwide attention. The group traveling with Paulson included two Los Angeles-based French journalists producing a half-hour program on the subject for a Swiss TV station.

Wearing shirts they designed and made, Tony Bolin and Kari Holvik-Bolin of Maple Grove, Minn., walk Henry (left) and Oscar during a rest stop in Orr on their way to Canada to buy insulin for Kari. She credits Oscar with saving her life a couple times, waking others when her blood sugar levels dropped too low while she was sleeping. (Steve Kuchera / skuchera@duluthnews.com)
Wearing shirts they designed and made, Tony Bolin and Kari Holvik-Bolin of Maple Grove, Minn., walk Henry (left) and Oscar during a rest stop in Orr on their way to Canada to buy insulin for Kari. She credits Oscar with saving her life a couple times, waking others when her blood sugar levels dropped too low while she was sleeping. (Steve Kuchera / skuchera@duluthnews.com)

$15,000 out of pocket

Pat Rogers, 62, Virginia, joined the group in International Falls with his brother Steve. Diagnosed with type 2 diabetes in 2004 while being treated for a major heart attack, Rogers takes two forms of insulin plus Victoza, a medication used to reduce the risk of cardiovascular complications.

Those medications combined cost about $5,000 for three months’ worth in the U.S., Rogers said. His insurance covers that, but only for the first three months of the year. That leaves him with $15,000 to spend out of pocket the rest of the year.

He estimated he’d be spending $1,300 for three months’ worth in Canada.

“It’s the Victoza; it’s expensive,” he said. “If it was just the insulin, I’d be having a party.”

If not having a party, those in the little group seemed to be enjoying their journey north on a day that was mild, with periodic showers. The Brehmens were making it a part of a mini-vacation that would include a couple of days at a fishing camp and visits to various family members.

The Bolins dressed for the occasion, wearing homemade T-shirts featuring a pill bottle and the words “Access to insulin is a human right.” They took along their good-natured little dogs, Henry and Oscar. Though not trained to do so, Oscar senses when Holvik-Bolin’s blood sugar is low and starts barking urgently, they said. Holvik-Bolin credits the dog with saving her life four times.

Pat Rogers of Virginia talks with pharmacist Bev Gushulak at the Fort Frances Shoppers Drug Mart. (Steve Kuchera / skuchera@duluthnews.com)
Pat Rogers of Virginia talks with pharmacist Bev Gushulak at the Fort Frances Shoppers Drug Mart. (Steve Kuchera / skuchera@duluthnews.com)

In Fort Frances

The group didn’t create much of a stir in the modest-sized brick drugstore. The pharmacist, who recently had returned to work after her year of maternity leave, handled the requests efficiently and calmly.

Terrence Brehmer was briefly taken aback by the price, forgetting the difference the exchange rate makes. Pat Rogers got his insulin but was told he had to have a Canadian doctor’s signature to get Victoza. The news didn’t alter his cheerful mood. The doctor’s visit would cost him $100, he was told, but the three months’ supply of the drug would cost him $450. In the U.S., it would be $4,200.

“So $100 for a doctor’s signature is nothing,” Rogers said.

The Bolins were equally pleased.

“Well if you figure just the financial savings alone, even with booking a hotel room and maybe getting dinner or breakfast, it’s still cheaper by a factor of 10 to do this,” Tony Bolin said.

If things don’t change, they’ll make the trip again next year, the couple said.

“Maybe we’ll go crazy and go to Winnipeg,” Kari Holvik-Bolin said, as her husband chuckled.

For the time being, they were just heading to another store, figuring they also could get a good price on medical supplies.