What to know about the 22-year-old Wisconsin man who died after his inhaler price spiked to $539

Yahoo

11-02-2025

On Jan. 10, 2024, 22-year-old Cole Schmidtknecht went to his pharmacy, the Walgreens at 729 W. Northland Ave. in Appleton, to refill his inhaler prescription — a preventive medication he'd been on since he was about 13, his parents said.
Cole was informed the medication was no longer covered by his insurance, and would cost him $539.19 out of pocket. It was more than he could afford, and more than he'd been asked to pay before. Instead, he left with a rescue inhaler.
Five days later, he had a severe asthma attack. His roommate drove him to the emergency room, but he never regained consciousness and died a few days later, on Jan. 21, 2024.
Last week, The Post-Crescent went in-depth on Cole's story. For readers whose time is short, here's what to know about the legal battle his parents are now fighting in his name.
Cole's parents, Bil and Shanon Schmidtknecht, filed a federal lawsuit against both Walgreens and OptumRx, a subsidiary of UnitedHealth Group, alleging both companies were negligent and bear responsibility for Cole's death.
The lawsuit seeks damages for Cole's suffering, as well as his funeral and burial expenses. The lawsuit is also an effort to bring change to a system they say is flawed.
"There's nothing that's going to bring Cole back. 'Justice' is probably monetary at this point, or whatever you want to call that. But it's not even about that," Bil Schmidtknecht said. "If we can be successful in this lawsuit, maybe it'll bring change."
OptumRx is a pharmacy benefit manager, also known as a PBM, which acts as a go-between for UnitedHealth Group with drug companies and pharmacies.
Most of the largest PBMs are owned by health insurance companies or their parent companies. Like UnitedHealth Group owns OptumRx, CVS Health Corporation owns CVS Caremark, Cigna owns Express Scripts, and Humana owns Humana Pharmacy Solutions.
The result of this vertical integration means PBMs have significant power over the pharmaceutical supply chain — and can inflate medication prices for Americans, the Federal Trade Commission has warned.
In 2023, the three largest PBMs — CVS Caremark, Express Scripts and OptumRx — processed close to 80% of the approximately 6.6 billion prescriptions dispensed by pharmacies around the United States, according to a 2024 FTC report. The six largest PBMs manage close to 95% of prescriptions in the country.
The complaint alleges:
PBMs are an "oligopoly" that "dictate patients' medications based on their own financial interests."
At the start of 2024, OptumRx discontinued coverage of the inhaler Cole used, Advair Diskus, and its generic versions, in a decision that was not medically motivated.
OptumRx's 2024 formulary — a list of medications covered by insurance — only listed coverage of two newer inhaler brands, whose manufacturer paid OptumRx "substantial kickbacks" to place those inhalers on the updated formulary and exclude Advair Diskus.
Cole was never provided the 30 days' notice required by Wisconsin law that his medication would no longer be covered under the new formulary, so he did not have the opportunity to request an exception to the formulary change through his doctor.
Employees at Walgreens did not help Cole get his medication, like asking Cole's doctor to request an exception to the formulary or approve an alternative medication that was covered. The family alleges Walgreens was understaffed and the staff available were not adequately trained to help Cole navigate the situation.
The lawsuit complaint was filed Jan. 21 in the U.S. District Court for the Eastern District of Wisconsin, almost a year after Cole's death. No hearing dates have yet been set.
Court documents stating the lawsuit summons and complaint had been served to OptumRx and Walgreens' parent company, Walgreens Boots Alliance, were filed on Feb. 3.
Since sharing their story, the Schmidtknechts have made appearances on media outlets like ABC News and "Good Morning America."
In December, Cole's story was shared at a Congressional hearing by Rep. Jake Auchincloss, D-Mass., in support of a bipartisan bill called the "Pharmacists Fight Back Act," which was introduced in July 2024 and sought to stop price-gouging by PBMs. However, it did not pass during the 2023-24 legislative session.
Just months after Cole's death, the manufacturer of the daily inhaler Cole took joined other drug manufacturers in announcing it would cap the out-of-pocket costs for inhalers at $35 a month. The price caps followed the launch of an investigation into inhaler prices by U.S. senators, including Sen. Tammy Baldwin, D-Wis.
Bil Schmidtknecht said he continues to work on grassroots efforts in Wisconsin for PBM reform.
Contact Kelli Arseneau at 920-213-3721 or [e-mail]. Follow her on X, formerly Twitter, at @ArseneauKelli.
This article originally appeared on Appleton Post-Crescent: Cole Schmidtknecht of Wisconsin died after his inhaler price spiked