In the heart of Wisconsin, a young man’s life was marked by resilience and determination.
Diagnosed with chronic asthma from infancy, Cole Schmidtknecht, 22, managed his condition diligently, never allowing it to overshadow his aspirations.
Friends and family recall his unwavering spirit and commitment to living life to the fullest.
For over a decade, Cole relied on his daily Advair Diskus inhaler, a medication that kept his asthma in check.
The cost of this essential inhaler typically ranged between $35 and $66.86, an expense Cole managed alongside his other responsibilities.
However, in the fall of 2023, unbeknownst to him, significant changes were underway.
OptumRx, a prominent pharmacy benefits manager and subsidiary of UnitedHealth Group, adjusted its formulary—the list of medications covered under insurance plans.
This adjustment led to the exclusion of Cole’s prescribed inhaler from coverage.
Crucially, Cole did not receive the mandated 30-day notice regarding this change, leaving him uninformed about the impending financial burden.
On January 10, 2024, Cole visited his local Walgreens pharmacy in Appleton, Wisconsin, to refill his prescription.
It was here that he encountered an unexpected and insurmountable obstacle.
The pharmacist informed him that his inhaler was no longer covered by insurance, and the out-of-pocket cost had escalated to $539.19.
This was a nearly $500 increase from its previous price.
Faced with this staggering expense, Cole was forced to make a harrowing decision.
Balancing his modest income, he chose to prioritize his rent and other essential living expenses.
Without access to his daily preventative medication, he relied solely on an older rescue inhaler to manage his symptoms.
Over the next five days, his condition deteriorated.
On January 15, 2024, Cole suffered a severe asthma attack.
His roommate rushed him to the emergency room, but during the journey, Cole became unresponsive.
Despite the valiant efforts of medical professionals, Cole remained in a coma.
After six days on life support, his parents made the heartbreaking decision to withdraw care.
Cole passed away on January 21, 2024.
In the aftermath of this tragedy, Cole’s parents, Shanon and William Schmidtknecht, have taken legal action.
They have filed a lawsuit against OptumRx and Walgreens, alleging negligence and wrongful death.
The lawsuit contends that OptumRx violated Wisconsin law by failing to provide the required 30-day notice of the formulary change.
It also accuses the company of making the medication prohibitively expensive without a valid medical reason.
Additionally, the lawsuit states that Walgreens staff did not offer Cole any affordable alternatives.
They allegedly failed to contact his physician to seek an exception or alternative treatment plan.
OptumRx has responded to these allegations, stating that their actions were consistent with industry practices.
They claim the changes were in line with the patient’s insurance plan design.
The company also noted that Cole had filled a prescription for a generic albuterol inhaler on the same day he attempted to purchase the Advair Diskus inhaler.
However, this albuterol inhaler is typically used as a rescue medication and does not replace the need for a daily preventative inhaler like Advair Diskus.
Walgreens has not provided a public comment on the lawsuit, citing ongoing legal proceedings.
This tragic case highlights the devastating impact of rising prescription drug costs.
It raises urgent questions about the accountability of insurance companies and pharmacy benefit managers.
As the lawsuit unfolds, Cole’s family is determined to seek justice for their son.
They hope their fight will prevent others from suffering a similar fate.
Featured Image Credit: (Credit: @facebook)
