Cole Schmidtknecht from Appleton could not afford his inhaler, died then

On By Littum

On January 10, 2024, 22-year-old Cole Schmidtknecht went to his pharmacy, Walgreens at 729 W. Northland Ave. in Appleton to fill his inhaler reception.

Diagnosed with asthma as a baby, Cole had taken the inhaler daily as a preventative medication since he was about 13, his parents said.

At Walgreens, Cole was informed that the medicine he had long been dependent on for daily use was no longer covered by his insurance, and would cost him $ 539.19 out of his pocket – more than eight times the maximum he ever had been charged with it, and about 15 times the highest price he would pay after meeting his ownership proportion.

It was more than he could afford. Cole left without buying it and only left a rescue inpato he was able to get with a copay of $ 5, his parents said.

Five days later, Cole had a severe asthma attack. His roommate drove him to the emergency room for the Tedacare Regional Medical Center in Appleton. When he arrived, he had no pulse and seemed blue, according to a trial.

Cole never regained consciousness. He died on January 21, 2024 in the hospital.

His family has brought a federal trial against both Walgreens and OptumrxA subsidiary of the United Health Group, who claimed that both companies were negligent and bearing responsibility for the death of coles.

The lawsuit seeks financial compensation for injuries, including the suffering colle that was made before he died and his funeral and funeral expenses.

“Our primary goal is to achieve justice for the Schmidtknecht family, who suffered an unimaginable loss in the loss of their 22-year-old firstborn son,” said Helen Lawless, one of the family’s lawyers. “To do that, they have decided to take a lawsuit against Optumrx and against Walgreens, both of whom contributed to Cole being unable to grab a medicine that he had taken for years without incident that would have saved his life “

But for Cole’s parents, car and Shanon Schmidtknecht, the main purpose of the trial is to bring change to a system they say are deficient.

“There is nothing that will bring Cole back. ‘Justice’ is probably monetary at this point or whatever you want to call it. But it’s not even about it,” said car Schmidtknecht. “If we can succeed in this trial, it might bring change.”

Walgreens refused to leave a comment with reference to the ongoing trial. Optumrx pointed to a statement that the company released last year after Cole’s death, where we said “We are saddened by the history of coles and our sympathy is with his family and loved -Astma medication options were handled in accordance with the industry’s practice and the patient’s insurance advance.

When the trial continues in the federal court, car and Shanon Schmidtknecht say they hope to shed light on a question affecting people across the country.

“We need real change,” Bil Schmidtknecht said.

Trial complaint says that the pharmacy’s benefit managers dictate patients ‘medicine based on their own financial interests’

Optumrx is a pharmacy’s benefit manager, also known as a PBM that acts as a space for the Unitedhealth Group with pharmaceutical companies and pharmacies.

According to the United Health Group’s site, Optumrx “helps reduce costs to the pocket of consumers, addressing the high cost of special medicine through integrated cost management and simplifying the pharmacy experience of our customers, care providers and consumers.”

Schmidtknechts’ trial claims this is not the case.

“They say they are trying to save you money, but they really collect discounts behind the scenes,” Car Schmidtknecht told Post-Crescent.

Most of the largest PBMs are owned by health insurance companies or their parent companies. Like UnitedThealth Group owns Optumrx, Own CVS Health Corporation owns CVS CaremarkCigna owner Express scriptsand Humana owner Humana Pharmacy Solutions.

The result of this Vertical integration Means that PBMs have significant power over the pharmaceutical supply chain – and can inflate drug prices for Americans, the Federal Trade Commission has warned.

In 2023, the three largest PBMs – CVS Caremark, Express scripts and OptumRX – dealt with close to 80% of the approx. 6.6 billion prescription that has been handed out by pharmacies around the US, according to A report from 2024 FTC. The six largest PBMs manage close to 95% of prescriptions in the country.

The report quotes A poll from Kaiser Family Foundation It found that nearly 30% of Americans surveyed reported on rationing or skipping doses of medicine due to high costs.

The Schmidtknecht family’s trial claims that PBMs are an “oligopoly” that “dictates patients’ medicine based on their own financial interests.” The complaint claims that at the beginning of 2024 Optumrx covered the cover of the Inhalator Cole used, Advair DiscusAnd its generic versions, in a decision that was not medically motivated.

The complaint claims Optumrx ‘Form from 2024, which is a list of medicines covered by insurance, only listed coverage of two newer inhalers whose manufacturer had paid OptumRX “significant setbacks” to place these inhalers on the updated form and exclude Advair Discus.

The complainant also claims that Cole never got 30 days notice required in Wisconsin Law That his medication would no longer be covered by the new form, so he did not have the opportunity to request an exception to the form change through his doctor.

Employees at Walgreens then did not take any steps to help Cole get his medication, such as asking Cole’s doctor to request an exception to the form or approve an alternative medication that was covered, the trial claims. The complaint accuses Walgreens of not training staff adequately how to ensure patients understand all options that are open to pharmacy services, partly as a result of understaffing.

So when Cole went into Walgreens to get his inhaler just five days before his catastrophic asthma attack, his only option was to pay $ 539.19 he couldn’t afford or leave without his medication, his lawyers claim.

“The construction of both Optumrx and Walgreens was regrettable,” said Michael Trunk, another lawyer representing Schmidtknechts in the trial, in a statement. “The evidence in this case shows that both Optumrx and Walgreens make profits first and are directly responsible for the death of coles.”

The trial was filed on January 21 in the US District Court of Eastern District in Wisconsin. No hearing dates have been set yet.

The court’s documents that the trial was called and complaint had been served to Optumrx and Walgreens’ parent company, the Walgreens Boots Alliance, was filed on Monday.

Schmidtknecht -Family Seeking Reform of Health Service

Since Cole’s death, his parents have been vocal in the effort to reform PBMs. As their trial has received national attention on A time of widespread control of the US health systemCar and Shanon Schmidtknecht have appeared on media as ABC News and “Good morning America“

“The drive that Shanon and I have to continue to try to get justice for him, making sure this doesn’t happen again, just comes out of Cole,” said Bil Schmidtknecht. “He got up for the little guys. He always felt he had to.”

In December, Cole’s story was were shared during a congressional hearing Of rep. Jake Auchincloss, D-Mass., In support of a bipartisan bill, called the “Pharmacists are fighting back,” It was introduced in July 2024 and tried to stop the price trend of PBMS.

The Bill did not adopt during the Legislative Meeting 2023-24.

Just months after Cole’s death, the manufacturer of daily inhalator COLE took with other drug manufacturers in advertising That would cover the cost of pocket of inhalers to $ 35 a month. The award hoods followed the launch of a survey of inhalator prices from the US Senate’s legislators, Including Senator Tammy BaldwinD-WIS.

Car Schmidtknecht said he continues to work on grassroots efforts in Wisconsin for PBM Reform.

When they seek justice, Schmidtknechts remembers their son as the young man, he was: curious, polite, quirky and adventurous and a lover of games, music and movies.

Shanon Schmidtknecht said Cole’s friends described him as “the most funny guy to talk to.”

“They said … You could sit and talk to him for hours,” she said. “He was just very knowledgeable and curious.”

Contact Kelli Arseneau at 920-213-3721 or [email protected]. Follow her on X, former Twitter, at @Arseaukelli.