Wisconsin couple sues Optum Rx and Walgreens for son’s asthma death
(FOX 9) - A Wisconsin couple has filed a lawsuit against Minnesota-based Optum Rx and Walgreens for their son’s asthma-related death one year ago.
Lawsuit filed in asthma death
The backstory:
Shanon and William Schmidtknecht of Poynett, Wis. lost their 22-year-old son Cole in January 2024. He stopped at a Walgreens in Appleton and was told that the price of his inhaler had jumped from $66 to $539 out of pocket. He left the pharmacy without the medication and tried to manage his condition with a rescue inhaler.
He suffered a fatal asthma attack days later. Cole had suffered from asthma his entire life and managed it with daily inhaler doses of the medication Advair Diskus and generic equivalents.
The lawsuit:
Optum Rx is a Pharmacy Benefit Manager that manages the prescription drug plan for Cole’s insurance plan through his employer.
The family alleges that Optum Rx violated Wisconsin law by raising the cost of the medication without a valid medical reason and failed to notify Cole so that he could talk to his doctor about alternatives.
The lawsuit also alleges that Walgreens failed to offer Cole a workaround, a generic or an emergency supply so that he could reach out to his doctor and insurance company.
Optum Rx is a Pharmacy Benefit Manager that negotiates drug prices for insurance plans. The industry has been under scrutiny by the Federal Trade Commission because just three companies control pricing for 80 percent of prescription drug pricing in the United States.
Those three companies are also in ownership chains with insurance companies and pharmacies, like mail order. The FTC has recently stated that it found PBMs to be artificially inflating generic drug prices for their own profits.
Response to the lawsuit
What they're saying:
In a statement last spring to FOX 47 in Madison, Wis., Optum Rx confirmed that Cole did not leave the pharmacy with his medication that day and only had a refill on a rescue inhaler.
Optum Rx sent this statement:
"We are saddened by Cole’s story and our sympathies are with his family and loved ones. 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.
"Our goal is to ensure medicines, including those used to treat asthma and other critical conditions, are accessible and affordable for Americans. After rigorous review of this case, we determined that formulary management and communications efforts that impacted this patient’s access to key asthma medication options were handled consistent with industry practice and the patient’s insurance plan design. Any members with questions about their coverage can call the number on their prescription card."
Pharmacy Benefit Managers reporting
Dig deeper:
You can see more of Fox 9’s investigations into drug pricing by clicking below.
- Independent pharmacies say they are being squeezed out:
- PBM Prime Therapeutics ordered to pay $10 million in damages for price fixing: https://www.fox9.com/news/prime-therapeutics-ordered-pay-10-million-price-fi
The backstory:
You can read the entire FTC staff report here.