Five days before 22-year-old Cole Schmidtknecht suffered a fatal asthma attack, a pharmacist informed him that the price of his inhaler had unexpectedly increased by 700%, a shocking price hike that forced him to leave without the prescription that could have saved his life.
Although Cole was insured, the Advair Diskus inhaler that had formerly cost less than $70, had spiked to over $500 — a surprise expense that was financially out of reach, NBC News reported. The short-acting rescue inhaler Cole was able to afford wasn't enough to counter the severe asthma attack that led to his death on January 21, 2024.
Now, his grieving parents, Bil and Shanon Schmidtknecht, are suing Optum Rx, the pharmacy benefit manager (PBM) that removed the inhaler from his insurance plan's formulary, and Walgreens, the pharmacy that they claim failed to offer affordable alternatives or notify Cole's doctor of the change.
The lawsuit alleges that Cole was not given proper notice of the formulary change and that the pharmacy did not follow up with his physician. PBMs like Optum Rx play a powerful but largely hidden role in determining drug availability and pricing through secretive rebate negotiations with pharmaceutical companies.
"It's insane that it's happening in America. [The system's] not broken — it's designed to work this way," Bil Schmidtknecht told NBC. "It's just hurting us."
The Schmidtknechts are also advocating for legislation requiring at least 90 days' notice before a medication is dropped from insurance coverage.
PBMs claim they offer affordable options and prioritize savings, but a January FTC report found the nation's three largest PBMs — CVS Caremark, Express Scripts, and Optum Rx — have raised the cost of a number of life-saving medications by billions of dollars. The named companies released individual statements calling the report misleading.
The lawsuit comes amid growing public backlash to the profit-driven healthcare system.
Last month, a mother in Arizona filed a lawsuit against her late son's health insurer. 36-year-old Ravi Coutinho selected his health insurance based on the availability of mental health and addiction services, yet he was unable to secure a therapist despite dozens of documented attempts. He died from complications with excessive alcohol use in May 2023.
"He was just so young, and he had his whole life ahead of him. It was so preventable and so unnecessary," Cole's mother, Shanon Schmidtknecht said. Her fight to impact policy is dedicated to the memory of her son.
"Justice for Cole, of course," she said, "But bigger than that, justice for us all."
Originally published on Lawyer Herald
