DocProject Provides Legal Support for Film on Human Cost of Insulin Crisis

A man and a woman standing in front of a house hold a framed photo of a young man
In a scene from the documentary Pay or Die, James Holt Jr. and Nicole Smith Holt hold a photo of their late son, Alec. Alec Holt died at age 26 — weeks after aging out of his parents’ health insurance — when he rationed insulin because he could not afford its $1,300 monthly cost. Students in DocProject, a program of the Media Freedom and Information Access Clinic at Yale Law School, provided legal review for the film. (Photo: Scott Alexander Ruderman)

Students provided legal review for a documentary coming to theaters this year that sheds light on America’s insulin affordability crisis. Directed by Scott Alexander Ruderman and Rachael Dyer, Pay or Die deals with the financial toll of medicine for people with Type I diabetes. 

The students were part of DocProject, a program of the Media Freedom and Information Access Clinic at Yale Law School. Under the guidance of experienced media lawyers, Yale law students provide filmmakers with pro bono legal research and advice from the earliest stages of their projects through rough cuts. The project’s mission is twofold: to assist documentary filmmakers who might not otherwise have access to legal resources, and to train the next generation of media lawyers.

Pay or Die tells the story of American families living with Type I diabetes who are struggling with the high cost of medicines. Dyer and Ruderman, who has Type I diabetes himself, began shooting the film in November 2018, showing people in a range of demographics in locations across the country. 

Pay or Die Directors Scott Alexander Ruderman and Rachael Dyer

“This is a condition that can affect everybody and anyone,” Ruderman said. “It doesn’t matter where you live, who you are, or your age.”

Dyer stressed that, although the film centers around insulin affordability, high cost is an issue with many medicines.

“Our film focuses on access to insulin, but we’re using it to look at the overall American health care system,” Dyer said. “This story isn’t unique to just people who need to access the insulin for a lifesaving condition; it covers so many other medications which are just too expensive to afford.” 

The unaffordability of these medicines, according to the film, is largely a function of profiteering by Big Pharma companies.

“To have the clinic on our side helped us push harder to continue making this film knowing that the law is also there to protect us.”
— Filmmaker Scott Alexander Ruderman

With its hard-hitting stance against an industry that’s well known for being litigious, Ruderman and Dyer knew that their film would need rigorous legal review. They found that DocProject’s pro bono legal support was a perfect solution for the independent filmmakers operating on a tight budget.

“We’re trying to convey the truth, to give voices to people that are unheard. But there’s a lot of fear around this. People think you can’t do that because you’ll get sued,” Ruderman said. “To have the clinic on our side helped us push harder to continue making this film knowing that the law is also there to protect us.”

DocProject students started work on the film in spring 2021. Visiting Clinical Lecturer Jennifer Borg characterized the students’ work as issue spotting, problem solving, and coming up with workarounds. 

“This is so much of what law is,” she said. “We didn’t lessen the impact of the film but we reduced the risk to the producers. At the end of the day, that’s the real success.”

The students began by combing through the film’s rough cut to identify any potential legal issues. Since the film was shot in several states and at an international crossing on the Canadian border, the students researched laws in each of these jurisdictions. This meant not only looking up the applicable statutes, but also trawling through the case law to see how they had been put into practice, and what risks they might expose the filmmakers and their subjects to.

A person wearing a baseball and jersey with the words "Long Live Al" and the number 26 on the back looks up at fireworks in the night sky.
A scene from the film. (Photo: Scott Alexander Ruderman)

The students’ research was vetted by clinical faculty members and by local counsel who practice in these jurisdictions.

“We could not do this clinic without the fabulous pro bono lawyers who’ve come to our aid and assisted us as local counsel around the country,” Borg said. “Overwhelmingly, the feedback has come back from our local counsel saying our student research has been spot on.”

At the end of the research process, DocProject students and faculty spoke with the directors to discuss the legal issues, risks, and potential ways to move ahead.

“One of the more fun parts of the job is meeting with the clients and explaining the issues and how risky a certain type of activity is in non-technical terms,” said Aren Torikian ’24, who worked on the film. “Being able to explain that to a client who is very smart but not a lawyer is a skill that I’ve honed in my time at DocProject.” 

Liza Anderson ’24, who also worked on the project, added that everyone on the team is invested in making the story as impactful as possible.

“We do exhaustive research to see if there is a way for the filmmaker to expand their reporting,” Anderson said. “If it is possible within the law to tell these stories, we’ll try to find a way for it to happen.”

For Ruderman and Dyer, the collaboration with DocProject was constructive. 

“If it is possible within the law to tell these stories, we’ll try to find a way for it to happen.”
— Liza Anderson ’24

“DocProject students helped us see the film through a perspective that would ensure that we wouldn’t harm any of our subjects or get ourselves in trouble,” Dyer said. “We were able to add that perspective to the mix while we were editing, and it went into a lot of the decisions we made about the final film.”

As it makes its way through film festivals and to a broader public, the filmmakers hope that their film will help raise awareness and build support for bipartisan reforms that would make life-saving medications accessible and affordable.

Pay or Die premiered at SXSW in March. It was selected as this year’s closing night film at the Human Rights Watch Film Festival, which wrapped up on June 8. The film was recently acquired by MTV Documentary Films, which is planning a theatrical release later this year, followed by a debut on streaming platform Paramount+.

The Media Freedom and Information Access Clinic (MFIA) is a law student clinic dedicated to increasing government transparency, defending the essential work of news gatherers, and protecting freedom of expression by providing pro bono legal services, pursuing impact litigation and developing policy initiatives.