The High Cost of Living - Man Dies After Being Unable To Afford Price Increase for Inhaler
Medical expenses in the U.S. healthcare system have long been a source of contention. Exorbitant costs for vital medication can destroy a family's finances. In some instances, they can take a life.
In a lawsuit filed in district court in Wisconsin on January 21, 2025, the family of Cole Schmidtknecht blames the death of their son on his inability to afford the almost $500 increase in the price of his asthma attack prevention inhaler. The suit names OptumRx, Walgreens Pharmacy, and Walgreen's parent company, Walgreen Boots Alliance, as defendants.
Taking His Breath Away
According to the suit, on January 10, 2024, 22-year-old Cole Schmidtknecht went to fill his prescription for his Advair Diskus asthma inhaler at his pharmacy of choice, an OptumRx-Walgreens in Appleton, Wisconsin. Expecting to pay the usual price of $66, Schmidtknecht was instead told that his insurance no longer covered the Advair Diskus and that his new cost was $539.19.
Unable to afford the price difference, Schmidtknecht left without the Advair Diskus. He attempted to rely on his backup "emergency" inhaler but suffered constant difficulty breathing without the preventative option offered by the Advair Diskus.
On Jan. 15, he was rushed to an emergency room by his roommate after experiencing extreme difficulty breathing. He arrived at the ER unresponsive and, despite receiving cardiopulmonary resuscitation (CPR) and spending days in an intensive care unit, never regained consciousness. Schmidtknecht died on Jan. 21.
PBMs Again
For a lawsuit about the high cost of medication, it might seem odd that the manufacturer of the Advair Diskus is not named as a defendant. The suit charges that OptumRx, in its role as a pharmacy benefit manager (PBM), was responsible for the unreasonable increase in price that led to Schmidtknecht's demise.
These accusations are nothing new for PBMs, which have recently come under increased scrutiny. As the middleman between the manufacturers and the pharmacies, PBMs are the final authority on drug and medical device pricing.
The suit alleges that Schmidtknecht was given no notice of the change in price and was not offered any generic replacement options at a more reasonable cost. It claims negligence against all three defendants and specifies that OptumRx is in violation of three Wisconsin statutes that establish a standard of care for PBMs.
Wisconsin laws require PBMs to give thirty days' notice for any change in the coverage tier for prescribed drugs. PBMs must also provide clinical proof before imposing step therapy as an accepted protocol.
In addition to a wrongful death cause of action, the suit enters the claim to Cole's estate by his parents. The damages sought are unspecified, although the suit carries two counts for the awarding of punitive relief.
The High Cost of Change
In a statement, OptumRx noted that Schmidtknecht refilled his Albuterol generic inhaler prescription on Jan. 10, 2024, for a $5 copay. They also claim to have clinically appropriate options for when a medication is not covered by an insurance provider.
By contrast, GSK, the manufacturer of the Advair Diskus, joined two other large drug companies in capping the price of their asthma and chronic obstructive pulmonary disease (COPD) inhalers at $35 per month for users. Announced soon after Schmidtknecht's death, GSK's cap went into effect on January 1, 2025.
Related Resources
- Wrongful Death Overview (FindLaw's Torts and Personal Injury Law)
- Medicine and the Law (FindLaw's Healthcare Law)
- Things You Should Know: Taking Prescription Medicines (FindLaw's Patient Rights Law)
