A 22-year-old man died from an asthma attack after the price of his medication skyrocketed. In the past, Cole William Schmidtknecht purchased his inhaler for $66 under his employment’s health insurance. But the pharmacist informed him the insurance no longer covered the preventative medication, and he had to pay $539. Cole left empty-handed and died five days later. His parents are now suing the pharmacy, Walgreens, in federal court.
Cole Schmidtknecht dies from an asthma attack
Cole Schmidtknecht had asthma since infanthood, but he managed it by using Advair Diskus, a preventative inhaler, every day. Since 2023, Cole received health insurance from his job to help cover the cost, so he had to pay only $66.86 USD each month. But that changed on January 10, 2024.
Cole went to his local Walgreens pharmacy with his prescription, only to be told his insurance no longer covered his medication, says the lawsuit. It now would cost him $539.19 out of pocket. Allegedly, the pharmacist told him there were no cheaper versions or generic brands he could buy instead. Additionally, the lawsuit states the pharmacist didn’t try to find an alternative or reach out to Cole’s doctor or insurance company.
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The family sues OptumRx and Walgreens
OptumRx is a pharmacy care services manager (PBM), which is a for-profit company that acts as a go-between drug companies and pharmacies. PBMs have power over supply chain as well as prices. According to the lawsuit, OptumRx updated its formulary in 2024 to state that patients using Advair Diskus or a generic alternative need prior authorization from their physicians before filling their prescription.
However, the Schmidtknechts allege that Cole was not told by Walgreens or his insurance that his medication won’t be covered, despite state laws making such notifications mandatory. As a result, he didn’t have the opportunity to contact his doctor about the formulary change.
After leaving Walgreens, Cole struggled with his asthma and depended on an old “rescue” inhaler that’s intended for quick relief since he didn’t have any daily maintenance inhalers left. Then, five days later, he had a severe asthma attack that made asphyxiate, says the lawsuit. His roommate took him to an emergency room but his heart stopped beating before they arrived. Medical personnel tried to resuscitate him, but he didn’t regain consciousness. For six days, he stayed on a ventilator in the intensive care unit. He was pronounced dead on January 21, 2024, after his parents chose to stop life support.
Now, his family is suing both Walgreens and OptumRx, a subsidiary of UnitedHealth Group for damages for their son’s suffering, as well as funeral and burial expenses. They also hope to bring change to prevent others from experiencing the same ordeal. “There’s nothing that’s going to bring Cole back. ‘Justice’ is probably monetary at this point, or whatever you want to call that. But it’s not even about that,” Bil Schmidtknecht said to Post Crescent. “If we can be successful in this lawsuit, maybe it’ll bring change.“
“Price-gouging and patient exploitation”
The lawsuit accused of OptumRx of changing their policy to stop covering certain drugs to favor two newer brands. Their manufacturers had paid the company for a better placement on the formulary. The Schmidtknechts’ attorneys called this change “non-medical switching” and say pharmacies get paid by manufacturers to force patients to switch to their medications. These changes are financially motivated, with no medical necessity, the suit alleged.
Rep. Jake Auchincloss from Massachusetts spoke about Cole William Schmidtknechts at a congressional hearing. He posted his speech on X (formerly Twitter) where he explained: “…Cole was forced to choose between paying for his medication, or for his rent. He chose to pay his rent…” Auchincloss then pushed for the Pharmacists Fight Back Act, which opposes pharmacy benefit managers’ (PBM) price-gouging and plans to “end patient exploitation” in federal health care plans. “No family should suffer the loss of a child from PBM greed,” he said
Similarly, the Schmidtknechts’ attorney, Michael Trunk said to HuffPost, “The evidence in this case will show that both OptumRx and Walgreens put profits first, and are directly responsible for Cole’s death.” He called the companies’ actions “deplorable”.
Capping the price of asthma medication
A few months after Cole’s death, drug companies Boehringer Ingelheim, AstraZeneca, and GSK voluntarily capped out-of-pockets costs for inhalers at $35, reported the Allergy & Asthma Network. This included the drug Cole used. This happened after a U.S. Senate committee began an investigation into asthma inhaler prices in April 2024, according to medical journal the Lancet. Meanwhile, Bil Schmidtknecht has continued to campaign for PBM reform on social media and with the organization Patient Protector, who highlights Cole’s story as an example of “PBM abuse”.
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