Today, nearly 2 million Americans are being held for ransom. Without insulin, they’ll be dead in days. PAY OR DIE follows 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.