22-Year-Old With Chronic Asthma Died After Inhaler Price Went From $66 to $539: Lawsuit

Yahoo

29-01-2025

The parents of a 22-year-old Wisconsin man who died after an asthma attack have filed a lawsuit against Walgreens and UnitedHealth Group's pharmacy benefit manager after they said the price for his medication suddenly rose from $66 to $539.
Cole Schmidtknecht, 22, had lived with asthma since he was a baby, but he was able to manage his symptoms by taking Advair Diskus, a preventative inhaler, every day, according to a lawsuit filed in federal court last week. Since 2023, Schmidtknecht had health insurance through his employer that covered his medication, which cost him no more than $66.86 each month.
However, when Schmidtknecht went to his local Walgreens pharmacy on Jan. 10, 2024, to fill his prescription, he was informed that his medication was no longer covered by his insurance, according to the lawsuit. Advair Diskus would now cost Schmidtknecht $539.19 out of pocket, and the pharmacy allegedly told him there were no cheaper alternatives or generic medications available to him. The lawsuit also says the pharmacist failed to contact Schmidtknecht's physician or insurance company to seek an alternative.
A spokesperson for Walgreens told HuffPost they could not comment due to the pending litigation.
According to the lawsuit, OptumRx, a company that acts as a middleman between pharmacies, insurance plans and drug companies, updated its 2024 formulary stating that a patient using Advair Diskus or a generic alternative prescription could only have it filled if they obtained prior authorization from a doctor.
The Schmidtknechts' lawsuit alleged 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, according to the lawsuit. He left Walgreens that day without filling his prescription, and in the days that followed, he repeatedly struggled to breathe and relied solely on an old emergency inhaler, per the suit.
Five days after he left Walgreens, Schmidtknecht had a severe asthma attack and began to asphyxiate, according to the lawsuit. His roommate drove him to an emergency room in Appleton, but he became unresponsive and his heart stopped minutes before they arrived.
Emergency room staff noted in their records that Schmidtknecht appeared blue. Despite efforts to resuscitate him, he never regained consciousness. Schmidtknecht remained on a ventilator in the intensive care unit for six days until his parents ended life support. He was pronounced dead on Jan. 21, 2024.
The lawsuit claims that 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. Attorneys representing the family referred to this practice as 'non-medical switching,' and say it's a way for pharmacy benefit managers to require patients to change medications in order to collect kickbacks from the drug manufacturer.
Rep. Jake Auchincloss, a Democrat from Massachusetts, honored Schmidtknecht at a congressional hearing in December, calling on lawmakers to pass his Pharmacists Fight Back Act, which he says aims to end the price-gouging practices of pharmacy benefit managers.
In a statement to HuffPost, the family's attorney, Michael Trunk, called OptumRx and Walgreens' conduct 'deplorable.'
'The evidence in this case will show that both OptumRx and Walgreens put profits first, and are directly responsible for Cole's death,' Trunk said.
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