The parents of a 22-year-old Wisconsin man who passed away following an asthma attack have sued Walgreens and the pharmacy benefit manager for UnitedHealth Group, claiming that the cost of his prescription drug unexpectedly increased from $66 to $539.
According to a lawsuit filed in federal court last week, Cole Schmidtknecht, 22, had asthma since he was a toddler, but he was able to control his symptoms by using Advair Diskus, a preventative inhaler, daily. Since 2023, Schmidtknecht’s employer has provided health insurance that covers his prescription drugs, which come to a monthly total of no more than $66.86.
According to the lawsuit, Schmidtknecht was told that his insurance no longer covered his medication when he went to his neighborhood Walgreens pharmacy on January 10, 2024, to fill his prescription.
Schmidtknecht would now have to pay $539.19 out of pocket for Advair Diskus, and the pharmacy allegedly informed him that he would not be able to obtain any generic or less expensive options.
Additionally, the lawsuit claims that the pharmacist neglected to look for an alternative by getting in touch with Schmidtknecht’s doctor or insurance provider.
The lawsuit alleges that OptumRx, a business that serves as a go-between for pharmacies, insurance plans, and pharmaceutical companies, revised its 2024 formulary to include a clause requiring a doctor’s prior authorization before a patient’s prescription for Advair Diskus or a generic alternative could be filled.
The Schmidtknechts’ lawsuit claimed that, in spite of state regulations requiring notification, neither Walgreens nor their son’s insurance company informed them in advance that their inhaler would no longer be covered.
According to the lawsuit, he left Walgreens that day without filling his prescription, and in the days that followed, he frequently had trouble breathing and had to rely only on an outdated emergency inhaler.
According to the lawsuit, Schmidtknecht suffered a severe asthma attack and started asphyxiating five days after leaving Walgreens.
His roommate took him to the Appleton emergency room, but just before they got there, he lost consciousness and his heart stopped beating.
Schmidtknecht looked blue, and the ER personnel recorded this in their notes. He never recovered consciousness despite attempts to revive him.
Before his parents turned off life support, Schmidtknecht spent six days in the intensive care unit on a ventilator. On January 21, 2024, he was declared deceased.
According to the lawsuit, OptumRx would only have covered two more recent brand-name medications whose maker had given OptumRx a sizable rebate in exchange for a favorable placement on the company’s updated formulary, rather than covering the generic counterparts of Advair Diskus.
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This tactic is known as “non-medical switching,” according to the family’s attorneys, who claim that pharmacy benefit managers use it to force patients to switch drugs in order to receive kickbacks from the drug maker.
At a congressional hearing in December, Massachusetts Democrat Rep. Jake Auchincloss paid tribute to Schmidtknecht and urged lawmakers to enact his Pharmacists Fight Back Act, which he claims attempts to stop pharmaceutical benefit managers from charging exorbitant prices.
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“The evidence in this case will show that both OptumRx and Walgreens put profits first, and are directly responsible for Cole’s death,” Trunk stated.
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