In early 2024, a tragic event in Wisconsin thrust the issue of pharmaceutical pricing into the national spotlight. Cole Schmidtknecht, a 22-year-old who had managed his chronic asthma with a reasonably priced inhaler, suddenly faced an insurmountable price hike—from a manageable $66 to a prohibitive $539. This sharp increase not only highlighted the volatile nature of drug pricing but also underscored the life-and-death implications such changes can have. As this case unfolds, it reveals a complex web of policies, corporate decisions, and human impacts that resonate far beyond a single pharmacy counter.
The Sudden Price Hike
On January 10, 2024, Cole Schmidtknecht walked into his local Walgreens, expecting to refill his prescription for Advair Diskus, a medication that had allowed him to manage his chronic asthma since infancy. What should have been a routine visit turned into a moment of crisis. The price for his inhaler had inexplicably jumped to $539.19—a staggering increase from the usual $66.86 he was accustomed to paying. Cole was told by the pharmacist that his insurance no longer covered the medication and that there were no cheaper alternatives or generic options available.
Faced with this sudden and unaffordable cost, Cole made the difficult decision to leave the pharmacy without his medication. According to a lawsuit filed by his parents, the pharmacy and the pharmacy benefit manager had failed to provide any prior notice of the change. “The evidence in this case will show that both OptumRx and Walgreens put profits first, and are directly responsible for Cole’s death,” said Michael Trunk, the family’s attorney, highlighting the gravity of the oversight.
This incident is a stark example of how price hikes in the pharmaceutical industry can create untenable situations for consumers, especially those depending on life-saving medications. The drastic price change not only left Cole without essential medication but also exposed broader systemic issues within healthcare management and pharmaceutical regulation.
Legal and Healthcare Context
The aftermath of Cole Schmidtknecht’s tragic experience at Walgreens illuminates a deeply entrenched issue within the U.S. healthcare system: the opaque and often controversial practices of Pharmacy Benefit Managers (PBMs). OptumRx, the PBM involved in Cole’s case, plays a pivotal role as a middleman between pharmacies, insurance plans, and drug companies. The lawsuit filed by Cole’s parents points to a troubling practice known as “non-medical switching,” where PBMs allegedly force patients to switch to more expensive drugs, not for medical reasons, but because of financial arrangements with drug manufacturers.
In Cole’s instance, the sudden reclassification of his inhaler on OptumRx’s formulary meant that the previously affordable Advair Diskus was replaced by pricier alternatives that provided the PBM with more substantial rebates from drug manufacturers. “OptumRx would not have covered Advair Diskus’s generic equivalents, and instead only covered two newer brand-name drugs whose manufacturer had paid OptumRx a substantial rebate for a favorable placement on the company’s updated formulary,” the family’s lawsuit alleges, highlighting a critical lack of transparency and patient consideration in formulary decisions.
This case also sheds light on the regulatory gaps that allow such practices to proliferate. Despite existing state laws requiring notification of changes in drug coverage, Cole and his family reportedly received no such communication. “Their son was not notified by his insurance or Walgreens ahead of time that his inhaler would no longer be covered, despite state laws that required notification,” underscores the legal challenge posed by the Schmidtknechts against the defendants.
As the legal proceedings unfold, they not only seek justice for Cole’s untimely death but also aim to challenge the status quo of the pharmaceutical industry’s pricing practices. Rep. Jake Auchincloss highlighted this broader issue at a congressional hearing, honoring Cole and calling for legislative reforms to curb the power of PBMs through his proposed “Pharmacists Fight Back Act.” This act is designed to end the price-gouging practices that, as in Cole’s case, can have fatal consequences.
Personal Impact and Tragedy
The consequences of the sudden price hike for Cole Schmidtknecht were immediate and devastating. After leaving the pharmacy without his medication, Cole relied on an old emergency inhaler, which was insufficient for managing his chronic asthma effectively. This stopgap measure proved tragically inadequate just days later. “Over the next five days, Cole repeatedly struggled to breathe, relying solely on his old ‘rescue’ inhaler to limit his symptoms, because he did not have a preventative inhaler designed for daily use,” recounted the lawsuit detailing the dire circumstances leading to his severe asthma attack.
The situation escalated on January 15, 2024, when Cole suffered a severe asthma attack that ultimately led to asphyxiation. His roommate, in a desperate attempt to save him, drove him to the emergency room. However, Cole became unresponsive and his heart stopped minutes before they could reach medical assistance. “When he presented to the ER, practitioners recorded that Cole was unconscious, pulseless, and appeared blue,” the legal documents describe, painting a harrowing picture of the young man’s final moments.
Emergency room staff worked tirelessly, administering epinephrine and performing CPR, but despite their efforts, Cole never regained consciousness. He remained on life support in the intensive care unit for six days until his heartbroken parents made the excruciating decision to end life support. He was pronounced dead on January 21, 2024.
This tragedy not only robbed a young man of his future but also left his family grappling with the preventable loss of their son. “This should never have happened,” expressed the family’s attorney, encapsulating the grief and frustration felt by the Schmidtknechts. Their ordeal highlights the personal toll of systemic issues within the healthcare system, where bureaucratic indifference to the needs of patients can lead to irreversible consequences.
Calls for Change
The tragic death of Cole Schmidtknecht has ignited a fervent call for systemic reform within the pharmaceutical and healthcare industries. The outcry is not just for justice for Cole, but for preventative measures to ensure that no other patient suffers due to the complexities and inefficiencies of pharmaceutical pricing and healthcare coverage.
In the wake of Cole’s death, Representative Jake Auchincloss took a stand at a congressional hearing, advocating for legislative changes aimed at curbing the exploitative practices of pharmacy benefit managers (PBMs). He introduced the “Pharmacists Fight Back Act,” a piece of legislation designed to tackle the kind of price-gouging and non-medical switching that contributed to Cole’s untimely demise. “It’s time to end these price-gouging practices by pharmacy benefit managers that, as we have seen all too tragically, can have fatal consequences,” Auchincloss stated, highlighting the critical need for oversight and reform.
The lawsuit filed by Cole’s family further underscores the demand for change, accusing OptumRx and Walgreens of prioritizing profits over patient care. “The evidence in this case will show that both OptumRx and Walgreens put profits first, and are directly responsible for Cole’s death,” said Michael Trunk, the attorney representing the Schmidtknecht family. This legal battle is not only about seeking justice but also about spotlighting the practices that allow such tragedies to occur.
Moreover, the Schmidtknechts hope that their son’s case will serve as a catalyst for introspection and change within the healthcare and pharmaceutical sectors. “Our hope is that this lawsuit and Cole’s death will lead them to kind of introspect on their own policies and change their policies going forward,” stated the family’s attorney. This sentiment is echoed across communities and stakeholders who are increasingly aware of the dire consequences of inadequate regulatory frameworks and the unchecked power of PBMs.
The Urgent Need for Reform in Healthcare
The heart-wrenching story of Cole Schmidtknecht is a grim reminder of the profound impact that healthcare policies and corporate practices can have on individual lives. His tragic death exposes deep flaws in a system where pharmaceutical pricing and insurance coverage decisions can mean the difference between life and death. The urgent calls for change, amplified by the devastating outcome of Cole’s reliance on an unaffordable medication, underscore the critical need for systemic reform.
As we reflect on Cole’s story, it is clear that this is not just an isolated incident but a symptom of a broader, systemic problem that affects countless other individuals. The introduction of legislation like the “Pharmacists Fight Back Act” and the legal challenges posed by Cole’s family are pivotal steps toward accountability and reform. However, true change will require persistent advocacy, informed public discourse, and legislative action to realign the priorities of healthcare systems with the needs of those they serve.
The hope is that Cole’s story will catalyze a movement towards more transparent, fair, and patient-focused healthcare practices. Only through concerted efforts to reform the ways in which drugs are priced and healthcare policies are implemented can we prevent future tragedies and ensure that no other family has to endure such a preventable loss.
In conclusion, Cole’s story is a call to action—a plea for all stakeholders in the healthcare system to prioritize human lives over profit and to work diligently towards a future where healthcare is accessible, affordable, and just for all.