With Americans increasingly crossing the border to buy insulin in Canada, prompting worries of a shortage, in a situation that Vermont Senator Bernie Sanders calls “an embarrassment”, it’s easy to wonder why insulin is so much cheaper up north.

Sanders joined a group of diabetics Sunday on their trip to Windsor, Ont., to buy the life-saving drug. The patients need the insulin to help regulate their blood sugar levels. The simple reason is Canada, like many other industrialized countries, has price controls on the cost of pharmaceuticals. The Patented Medicine Prices Review Board ensures the price of patented medicine sold in Canada is “not excessive” and remains “comparable with prices in other countries.”

The Canadian Press Sen. Bernie Sanders and a busload of insulin patients stopped in Windsor, Ont. on July 20, 2019 to highlight the high costs of the insulin in the United States.

There are limits to what the board can do, however, as it has no control over mark-ups by retailers, doesn’t set the price that public or insurance drug plans will reimburse, and doesn’t control pharmacist filling fees. It also doesn’t regulate the price of generic drugs. The U.S., on the other hand, has no regulations on the price of pharmaceuticals like insulin. Opponents of price controls claim they limit drug companies’ abilities to innovate and give consumers fewer options to choose from. Pharmaceutical company Pfizer conducted studies that suggested price controls on drugs would reduce life spans. Opponents exist in Canada too. William McArthur, a B.C. doctor, believes Canadian price controls and the long period it takes for new drugs to get approved can sometimes keep patients from being treated properly, the Mother Nature Network reported.

Samara Heisz via Getty Images People in the United Stares are paying six to two times more for a bottle of insulin. Americans are heading to Canada to purchase the pharmaceutical drug for cheaper.

People in the U.S. pay two to six times more than the rest of the world for brand name prescription medicine, according to the International Federation of Health Plans. Technically, it’s not yet legal federally for Americans to bring drugs from Canada back into their country, but as long as they’re not importing more than 3 months worth, and the drugs aren’t controlled substances like narcotics, border officials and the FDA look the other way. Many states have already passed legislation to allow it. Canadian drug imports are technically banned because of the belief that pharmaceuticals north of the border don’t face the same rigorous standards those in the south do, though a Senate study acknowledged that standards “are stringent and comparable to US standards.”

Since insulin doesn’t require a prescription north of the border, it’s one of the drugs Americans commonly import, especially since the cost of insulin in the U.S. has gone up 97 per cent in four years, according to CBC News. When Frederick Banting co-discovered insulin in the 1920s, he sold his share of the drug’s patent to the University of Toronto for $1 because he wanted the life-saving medicine to stay accessible. Nowadays, a vial of insulin Type 1 diabetics need to regulate their blood sugar costs about US$340 in south of the border, roughly 10 times the price in Canada.

Reuters Hugo Sego who lives with type 1 diabetes, hugs his mother Kathy during a rally with U.S. Sen. Bernie Sanders after purchasing lower cost insulin in Windsor, Ont. on July 28, 2019.