22-Year-Old Dies After Inhaler Price Jumps From $35 to $539

A Wisconsin couple is taking legal action against their son’s health insurance company and pharmacy, alleging that a sudden and unaffordable price increase on his asthma medication contributed to his death.

A Routine Refill Turns Tragic

Cole Schmidtknecht, 22, had managed his asthma for years with a daily Advair Diskus inhaler. However, when he went to refill his prescription at a Walgreens in Appleton, Wisconsin, on Jan. 10, 2024, he was told it was no longer covered by his insurance, according to a lawsuit filed by his parents, Shanon and William Schmidtknecht.

Previously, Cole’s medication cost $35 with insurance, but that day, he was told he’d have to pay $539.19 out-of-pocket - an amount nearly equivalent to a month’s rent. Unable to afford it, Cole left the pharmacy with only a $5 generic Albuterol inhaler, a rescue inhaler used to stop asthma attacks but not designed for daily symptom control.

A Deadly Asthma Attack

Over the next five days, Cole relied solely on his rescue inhaler, but his condition worsened. On Jan. 15, 2024, he suffered a severe asthma attack. His roommate rushed him to the hospital, but while in the car, Cole became unresponsive.

At the emergency room, doctors managed to resuscitate him, but he had already suffered severe brain damage due to lack of oxygen. Six days later, his parents made the heartbreaking decision to remove him from life support. His cause of death was listed as status asthmaticus, a life-threatening form of asthma exacerbation.

Who’s to Blame?

The lawsuit, filed against Optum Rx (Cole’s insurance provider) and Walgreens, alleges that Cole was not properly notified of the medication price increase or given the option of a generic alternative. According to his parents, Walgreens also failed to contact Cole’s doctor to explore more affordable options, despite instructions from Optum Rx to do so.

Optum Rx has defended its actions, stating to Fox 47 News: “We have reviewed his claims history and can confirm that he did fill a generic Albuterol prescription, an inhaler used to stop asthma attacks, on January 10, 2024, with a $5 copay. The same drug was previously filled in October 2023 by the member. Optum Rx also has available clinically appropriate options and formulary information when a medication is not covered on formulary, including Advair Diskus formulary alternatives with member copays as low as $5.”

However, the Schmidtknechts argue that Cole was never informed of those alternatives. His father later encountered the same issue with his own Advair prescription but was able to resolve it because his independent pharmacist took the extra step of calling the insurer for alternatives - something Walgreens allegedly failed to do for Cole.

A Bigger Fight for Change

For Cole’s parents, their lawsuit isn’t just about justice for their son - it’s about preventing similar tragedies. They are advocating for pharmacy benefit manager (PBM) reform, targeting companies like Optum Rx that negotiate drug pricing and coverage but have been criticized for prioritizing profits over patient care.

The Schmidtknechts are now working on “The Cole Schmidtknecht PBM Reform Bill,” aimed at increasing transparency and preventing sudden, life-threatening medication cost increases. Wisconsin lawmakers are considering a special legislative session in April to address the issue.

“It’s all down to the bottom dollar … and it’s costing lives,” said Bil Schmidtknecht to Fox 47 News. “There’s people out there being affected from asthma medicine to diabetic medicine, and cancer medicine to transplant medicine.”

For grieving parents like the Schmidtknechts, the fight is personal. While they can’t bring their son back, they are determined to ensure that no other family loses a loved one over the cost of a lifesaving medication. “He would never let this just be OK,” Shanon Schmidtknecht said to Fox 47 News. “And so we can’t either.”

References: When the Cost of His Asthma Inhaler Went Up $500, His Parents Claim He Couldn’t Pay. Two Weeks Later He Was Dead at 22 | Parents push for reform after son couldn’t afford new cost of meds, died of asthma attack