Why don't people just get insulin?

When someone hears that a person with diabetes went without insulin, the first reaction is usually confusion. It is a prescribed, life-saving medication in a country with public healthcare. Why would anyone go without it? The answer is that the barriers are real, they stack on top of each other, and most of them are invisible until you or someone you love is the one holding the prescription.

The price of insulin itself

OHIP covers your doctor. It does not cover the prescription your doctor writes. Insulin in Canada is far cheaper than in the United States, but it is not free:

A single vial of modern insulin typically costs roughly $30 to $60 at a Canadian pharmacy. Pens and cartridges, which most people find easier and safer to use, generally cost more.
Many people need more than one vial or box per month, and many need two different insulins at once: a long-acting insulin for background control and a rapid-acting insulin for meals. That can double the bill.
Dispensing fees apply on every fill, and costs recur every month, for life.

Figures on this page are approximate Canadian retail ranges. Actual prices vary by product, dose, and pharmacy.

The hidden costs nobody warns you about

Insulin is only one line on the receipt. Using it safely requires a small ecosystem of supplies, almost all of which run out and need to be repurchased:

Test strips, often around a dollar each, used several times a day. Testing 4 to 8 times daily can quietly cost more per month than the insulin itself.
Continuous glucose monitors, the sensors many clinicians now recommend, can cost hundreds of dollars a month without coverage.
Pen needles or syringes, which should be used once and replaced. People short on money reuse them, which is painful and risks infection.
Lancets, alcohol swabs, ketone strips, glucagon kits, and sharps containers, each small, each recurring, each adding up.

Added together, the numbers are not small. Diabetes Canada, which has tracked out-of-pocket costs since 2001, reports that more than half of Canadians with type 1 diabetes pay over $3,100 per year out of pocket, with its composite cases running as high as $18,306 per year for a youth using a pump and sensors, and low-income seniors in some provinces spending up to 20% of their income on diabetes costs. For a family already stretched thin, that is not a budgeting problem. It is an impossible choice between medication and rent.

The insurance gaps people fall through

Ontario has public drug programs, but they cover specific groups, and a large share of working-age adults fits none of them:

OHIP+ covers many prescriptions for people under 25, but only if they have no private insurance at all.
The Ontario Drug Benefit covers seniors 65 and over and people receiving social assistance.
The Trillium Drug Program helps households with high drug costs, but only after an income-based deductible, roughly 4% of after-tax household income, paid out of pocket first, every year.

That leaves the people in between: part-time, contract, and gig workers whose jobs come without benefits. Small-business owners. People between jobs, and people whose new benefits have not started yet. Newcomers in waiting periods. People whose private plan has an annual cap, a high deductible, or a copay that still puts insulin out of reach. Being uninsured in Ontario is rarely a permanent identity. It is a gap that ordinary life events open under people, often at the worst possible moment.

It is not only about money

Even when insulin is affordable, starting it is genuinely hard, and the system rarely acknowledges that:

Fear of needles is real. Being told you must inject yourself, sometimes several times a day, is frightening. Some people delay starting insulin for months because of injection anxiety, and they are often too embarrassed to say so out loud.
Stigma. Many people hide their diabetes at work or in public, skipping doses rather than injecting in front of others.
Rationing. When money runs short, people stretch their supply: skipping doses, taking less than prescribed, reusing needles, or testing less often. This is well documented. In the United States, researchers estimate about 1.3 million adults ration insulin because of cost, and repeated studies show the rate has not improved between 2017 and 2024. Rationing insulin is dangerous, and it is usually invisible until something goes wrong.
Navigating help is a job in itself. Assistance programs exist, but finding them, understanding eligibility, and filling out forms takes time, literacy, and energy that someone in crisis may not have.

Gestational diabetes: a crash course nobody signed up for

Gestational diabetes develops during pregnancy and affects roughly one in ten pregnancies in Canada. It is usually diagnosed between 24 and 28 weeks, and from that moment everything moves fast: a new diet, finger-prick testing several times a day, and for some, insulin injections, all while pregnant, all with no warning and no time to save up.

The costs arrive mid-pregnancy, stacked on top of everything else a growing family is already paying for, and coverage for strips, sensors, and insulin varies widely.
The fear is doubled. Many patients are asked to inject themselves for the first time in their lives while worrying about their baby with every dose.
And then, for most, it simply ends. Insulin needs typically stop at delivery, which means packages of completely unopened insulin are often left over, and today that insulin is destroyed.

That last point is why gestational diabetes appears twice in our work: families facing sudden, unplanned costs are exactly who the Insulin Access Fund is designed to help, and the safe, unopened insulin left behind is exactly what the Insulin Recovery Initiative wants to stop wasting.

A global problem, not just a Canadian one

Canada sits in the middle of a worldwide affordability crisis:

In the United States, the list price of Humalog rose from $21 in 1999 to over $300 two decades later, and three manufacturers control roughly 99% of the global insulin market by value.
In low-income countries, a month's supply of insulin costs several times more of a worker's wages than in high-income countries, and insulin was available in only about a third of surveyed facilities across 17 countries.
T1International's 2024 survey of patients in over 50 countries found people spending, on average, almost 12% of their income on insulin and glucose-monitoring supplies alone.

What this means for our work

None of these barriers is solved by lecturing people to take their medication. They are solved by lowering the real cost, simplifying the path to help, treating injection fear as a legitimate clinical issue rather than a character flaw, and building a system that stops throwing safe insulin away while patients go without. That is the work The Austin Project exists to advance.

If you work in diabetes care and see these barriers every day, we would like to hear what we are missing. Get in touch.