The old formulas you can buy OTC for $25 are more inconvenient to use, but will indeed keep you from dying. The main difference between the R insulin and Novolog/Humalog are how quickly they act. Novolog starts lowering your glucose in about 60 minutes while the R takes 2 hours. Dietary management is not related to which insulin you’re using, at least for type 1. The long acting substitute, NPH, is a lot more difficult to use than Lantus though. It still works. I ran out of good insulin on a trip last year and had to sub the R and NPH and did have some issues with hypoglycemia. I’m more qualified to swap them on my own than many people though (lots of people are not informed enough to change their dosage without professional medical advice).

So yes, the claim that OOP’s only alternative to paying $800 was to die is not true.