My neighbor’s daughter has Type 1 diabetes. In Texas, her insulin costs $1,200 a month with insurance. Good insurance. The kind where you pay $800 monthly just to have the privilege of paying $1,200 for life-saving medication.
She moved to Madrid last year to teach English. Now she pays €30 for a three-month supply.
Not monthly. Total. For three months.
She cried at the pharmacy the first time. The pharmacist thought something was wrong. Nothing was wrong. Everything was finally right.
The Insulin Racket Nobody Wants to Discuss
Americans with diabetes ration insulin. They’re literally dying because they can’t afford the thing that keeps them alive. Meanwhile, the exact same insulin—same manufacturer, same packaging, same everything—costs 90% less everywhere else.
Humalog in the US: $274 per vial (cheapest price if you know where to look) Humalog in Spain: €28 per vial (full price, no insurance)
NovoLog in the US: $289 per vial NovoLog in Spain: €31 per vial
These aren’t generic knockoffs. It’s the SAME INSULIN. Made in the same facilities. Sometimes literally the same batch numbers.
The Spanish government negotiates prices. They tell Novo Nordisk “this is what we’ll pay” and Novo Nordisk says “okay” because something is better than nothing and also because they’re still making profit at €31 a vial. They’re not taking losses out of the goodness of their hearts.
Which means that $289 price in America? That’s just because they can.
How the Spanish System Actually Works
Spain has universal healthcare but that’s not even the whole story. Even if you’re not in the system—tourist, illegal immigrant, someone who fell through the cracks—insulin costs €30-40 at any pharmacy. No prescription needed for regular insulin. Walk in, ask for it, walk out.
My neighbor’s daughter has a student visa. That’s it. She pays into social security (like €60 monthly for full coverage as a student). Her insulin is basically free through the public system. She pays the €30 just to have extra. Backup supply. Peace of mind.
Spanish people don’t understand American medical bills. They literally cannot comprehend it. Someone tried to explain American healthcare to my landlord and he thought they were joking. “But what if you’re sick?” he kept asking. “What if you have no money?”
The idea that you’d die because you can’t afford insulin doesn’t compute here. It’s like explaining you can’t have water because you didn’t pay the air bill. It makes no sense.
The Other Medications That Are Basically Free
My friend’s mom visited from Florida. She takes Eliquis for blood clots. Costs her $500 monthly in the States with Medicare Part D.
She ran out while here. Panicked. Went to a Spanish doctor (€50 visit, no insurance). Got a prescription. Went to the pharmacy.
€43. For a month supply.
She bought six months worth. TSA gave her a hard time flying back but she didn’t care. That’s $2,500 worth of medication in America for €258.
Actually wait, let me check that math. Six months at $500 is $3,000. She paid €258. That’s… she saved $2,700 by taking a vacation to Spain.
Why Americans Are Flying Here for Prescriptions
There’s a whole underground network of Americans who fly to Spain for medications. Not medical tourism with fancy clinics. Just regular people buying regular medicine at regular pharmacies.
Flights from New York to Madrid: $400-600 roundtrip Week in a cheap hotel: $300 Medications for the year: $200-500 Total: ~$1,500
Versus paying $12,000 for the same medications in America.
The math is so obvious it hurts. People are taking “vacations” that are really pharmacy runs. They see a doctor here (easy to get appointments, €50-100 for private visit), get prescriptions for the year, stock up.
Technically legal? Grey area. Spanish pharmacies can fill prescriptions from Spanish doctors for anyone. Taking medication back to America for personal use is usually fine. Usually.
Some medications have limits. Controlled substances are complicated. But blood pressure meds? Diabetes supplies? Cholesterol pills? Load up.
The Medicines That Shock Americans Most
Ventolin inhaler: $50-80 in US / €3 in Spain People literally can’t believe this. Three euros. For the exact same inhaler that costs a day’s wages in America.
EpiPen: $600-700 in US / €45 in Spain Parents here just… have them. In drawers. In cars. Just in case. Because they cost less than a nice dinner.
Insulin pens: $500+ in US / €25-35 in Spain The fancy pens that make dosing easier. American diabetics save for them. Spanish diabetics complain they’re too bulky.
Jardiance (diabetes): $500 in US / €35 in Spain Humira (autoimmune): $5,000 in US / €200 in Spain (still expensive but…) Synthroid (thyroid): $40 in US / €4 in Spain
That thyroid medication? Spanish people complain about paying €4. They think it should be free.
How My Landlord’s Medical Adventure Broke My Brain
Carlos, my landlord, needed heart surgery. Actual open-heart surgery. Triple bypass.
In America, that’s bankruptcy. Even with insurance. My uncle had the same surgery in Ohio—bill was $200,000, insurance covered $150,000, he still owed $50,000. Lost his house.
Carlos paid €0.
Zero. Nothing. Nada.
He complained about the €15 parking fees at the hospital.
The surgery was in January. He was back fixing my leaky faucet by March, complaining that the doctors made him rest too long.
His biggest expense was the coffee from the machine because the free hospital coffee was terrible.
But What About the Taxes?
Everyone says “but the taxes!” Like that’s some gotcha that makes American healthcare make sense.
Spanish income tax: 24-45% American federal tax: 22-37% Plus state tax: 0-13% Plus American health insurance: $500-1,500 monthly Plus deductibles: $5,000-10,000 Plus copays and coinsurance and whatever else
Do the actual math. Americans pay more in taxes + healthcare than Spanish people pay in just taxes. And Spanish people don’t go bankrupt from cancer.
A Spanish family making €40,000 pays about €8,000 in taxes. That includes healthcare, education, everything.
An American family making $40,000 pays $6,000 in taxes, $12,000 in health insurance, then still pays when they get sick.
The Prescription Tourism Guide Nobody Asked For
If you’re thinking about this (you’re thinking about it), here’s what people actually do:
Getting the Appointment Private doctors in Spain see anyone. Cost: €50-150. They speak English in tourist areas. Bring your American medical records. They’ll write prescriptions.
Public system requires residency. But some regions give temporary cards to anyone who registers at the town hall. Depends where you go.
The Pharmacy Situation Spanish pharmacies are marked with green crosses. They’re everywhere. Like Starbucks in Seattle.
Most medications don’t need prescriptions. Antibiotics do. Controlled substances do. But blood pressure meds? Cholesterol? Diabetes? Often just ask.
Maximum Quantities They’ll sell you 3-6 months supply usually. Depends on the medication and the pharmacy. Some don’t care. Some are strict. The ones near airports know what you’re doing.
Crossing Borders Keep medications in original packaging. Bring the prescription. Bring a letter from the doctor if possible. Most TSA agents don’t care about blood pressure medicine.
But technically there are limits. 90-day supply is generally safe. More than that gets complicated.
Why Spanish Pharmacists Think Americans Are Insane
Showed a pharmacist friend the American price for insulin. She literally didn’t believe me. Thought I was confused about the decimal point.
“No, it’s really $300 for one vial.”
“300 euros?”
“Dollars. But yes.”
“For how many vials?”
“One.”
“That’s impossible.”
Showed her the CVS website. She stared at it for a full minute. Then asked if Americans make more money to afford these prices.
Explained that minimum wage is $7.25 an hour.
She did the math. Realized someone would need to work 40 hours to buy one vial of insulin. The thing they need to not die.
“But that’s… that’s murder.”
Yeah, Cristina. It is.
The Weird Loopholes and Workarounds
Some Americans are getting Spanish private insurance just for the prescriptions. Costs €50-100 monthly, covers prescription costs, no deductibles.
There are companies now that coordinate this. Not quite legal, not quite illegal. They help you establish “residency” (register at an address), get insurance, see doctors, get prescriptions. Costs $2,000-3,000 for their services but saves people $20,000 annually.
Digital nomad visas make this easier. Stay a year, get in the health system, stock up on medications. Some people are just cycling through European countries on tourist visas, buying medications each place.
One guy I met comes every three months. Long weekend in Barcelona. Sees his doctor, gets prescriptions, eats tapas, flies home. Calls it his “medical vacation.” Cheaper than buying the same medications in Arkansas.
The Medications You Still Can’t Get
Adderall basically doesn’t exist here. ADHD medications are different. More restricted. Spanish doctors think Americans overmedicate ADHD.
Opioids are nearly impossible. Spain doesn’t have an opioid crisis because they barely prescribe them. Broken leg? Here’s ibuprofen. Surgery? Ibuprofen and maybe tramadol for three days.
Some American brand names don’t exist but the generic does. Different names, same chemical. Pharmacists can usually figure it out.
Certain formulations are different. Extended release might be immediate release. Doses might be different. The 40mg pill you take might only come in 50mg here.
What This Actually Means
People are dying in America because they can’t afford insulin. Meanwhile, the same insulin costs less than a nice lunch in Spain.
That’s not a healthcare system. That’s a hostage situation.
Spanish people complain their system isn’t perfect. Wait times for non-urgent surgery. Overworked doctors. Old hospitals. But nobody dies because they can’t afford insulin. Nobody goes bankrupt from cancer. Nobody chooses between heart medication and rent.
My neighbor’s daughter? The one with diabetes? She’s staying in Spain. Not for the culture or the lifestyle or the beaches.
For the insulin.
Because in America, she can’t afford to live. Literally.
In Spain, insulin costs less than her phone bill.
The Math That Makes Me Want to Scream
American with diabetes annual cost:
- Insulin: $14,400
- Supplies: $3,600
- Doctor visits: $1,200
- Total: $19,200
Spanish resident with diabetes annual cost:
- Insulin: €120
- Supplies: €200
- Doctor visits: €0
- Total: €320 ($350)
That’s not a pricing difference. That’s a different universe.
Americans fundraise for insulin. Have GoFundMe pages. Ration doses. Share supplies in Facebook groups like it’s contraband.
Spanish people don’t even think about it. It’s just there. Like water from a tap.
The entire American healthcare system is a scam and everyone knows it but nothing changes because the people making money off it also make the laws.
Meanwhile, in Spain, insulin costs €30.
Thirty euros.
Less than a tank of gas.
Less than a nice dinner.
Less than what Americans spend on coffee in a week.
But in America, it costs enough to bankrupt you.
Make it make sense.
About the Author: Ruben, co-founder of Gamintraveler.com since 2014, is a seasoned traveler from Spain who has explored over 100 countries since 2009. Known for his extensive travel adventures across South America, Europe, the US, Australia, New Zealand, Asia, and Africa, Ruben combines his passion for adventurous yet sustainable living with his love for cycling, highlighted by his remarkable 5-month bicycle journey from Spain to Norway. He currently resides in Spain, where he continues sharing his travel experiences with his partner, Rachel, and their son, Han.