The rising cost of prescription medication has been a concern for millions of individuals across the United States. When life-saving medicine becomes unaffordable, the consequences can be devastating. This was the reality faced by 22-year-old Cole Schmidtknecht, whose family believes his loss could have been prevented if his medication had remained accessible.
Cole’s story has now sparked national discussions on healthcare affordability, insurance policies, and the role of pharmacy benefit managers (PBMs). His case has also led to a lawsuit and a push for legislative action to prevent similar tragedies in the future.
A Life Cut Short: The Story of Cole Schmidtknecht
Cole Schmidtknecht was a young man from Wisconsin with a promising future ahead. Since infancy, he had lived with chronic asthma, a condition that required daily management through medication. With the help of his prescribed inhaler, Advair Diskus, Cole was able to lead an active life without significant limitations.
For years, Cole’s prescription was covered by his insurance, making it affordable for his family. However, in January 2024, everything changed.
Unexpected Insurance Changes: A Life-Saving Medication Becomes Unaffordable
On January 10, 2024, Cole visited his local Walgreens pharmacy to refill his prescription, as he had done many times before. This time, however, he was informed that his insurance would no longer cover Advair Diskus.
The cost of his inhaler had skyrocketed from $66 to $539—an amount that was beyond his immediate means. To make matters worse, the pharmacist allegedly did not provide alternative options or guidance on seeking an alternative solution.
Cole, overwhelmed by the situation, left the pharmacy without his medication. He attempted to manage his condition using an older emergency inhaler, but five days later, he suffered a severe respiratory episode.
A Medical Emergency and a Heartbreaking Loss
On January 15, 2024, Cole experienced a serious asthma attack that left him struggling to breathe. His roommate quickly rushed him to the emergency room, but on the way, Cole became unresponsive.
Doctors worked tirelessly to stabilize him, and he was placed on life support. Despite their best efforts, Cole never regained consciousness. After six days in intensive care, his family made the painful decision to let him go on January 21, 2024.
Cole’s passing sent shockwaves through his community, with his family and friends expressing their grief and frustration. They firmly believe that had he received his medication, this tragedy could have been prevented.
A Legal Battle for Accountability
Determined to seek justice, Cole’s family has filed a lawsuit against Walgreens and OptumRx, the pharmacy benefit manager (PBM) responsible for managing prescription coverage.
The lawsuit alleges:
- Lack of Notification: Cole and his family were never informed that his medication would no longer be covered.
- Failure to Provide Alternatives: The pharmacy did not guide Cole toward more affordable options or facilitate communication with his doctor.
- Financial Interests Over Patient Care: The lawsuit claims that profit-driven decisions led to Cole’s situation, forcing patients toward higher-cost medications rather than affordable, established treatments.
Attorney Michael Trunk, representing the family, stated:
“The evidence in this case will show that both OptumRx and Walgreens placed financial interests over patient well-being, leading to a preventable tragedy.”
The Issue of Prescription Affordability in the U.S.
Cole’s story is not an isolated incident. Across the United States, millions of patients struggle with rising prescription costs, especially when:
- Insurance policies change without warning, suddenly removing coverage for essential medications.
- Generic alternatives are not always made available or recommended.
- Pharmacy benefit managers influence pricing through agreements with pharmaceutical manufacturers.
The high cost of asthma medication has been a particularly pressing issue. Studies indicate that nearly one in four asthma patients in the U.S. ration or delay medication due to cost concerns.
This problem is further exacerbated by complex insurance policies that require patients to seek prior authorization before accessing medications previously covered without issue.
Calls for Change: Advocating for Fair Pricing and Transparency
Following Cole’s passing, healthcare advocates and legislators have intensified their efforts to improve transparency and affordability in the pharmaceutical industry.
One of the key voices in this movement is Rep. Jake Auchincloss of Massachusetts, who honored Cole during a congressional hearing in December 2024. He emphasized the urgent need for legislative reform, highlighting the importance of preventing similar cases in the future.
A proposed bill, the Pharmacists Fight Back Act, aims to:
- Increase transparency in prescription drug pricing and ensure patients receive advance notice of changes.
- Limit the power of pharmacy benefit managers to dictate coverage based on financial incentives rather than patient needs.
- Strengthen patient rights, ensuring they have access to necessary medications without excessive bureaucratic hurdles.
What This Means for Patients and Families
The tragic loss of Cole serves as a powerful reminder of the impact of prescription costs on individuals and families. It highlights the need for clear communication between pharmacies, insurance providers, and patients to ensure life-saving medications remain accessible.
Patients and families can take proactive steps to navigate these challenges:
- Regularly Review Insurance Plans – Understanding coverage changes before they take effect can help avoid unexpected medication costs.
- Consult with Healthcare Providers – If a medication becomes unaffordable, doctors may suggest alternatives or assistance programs.
- Explore Patient Assistance Programs – Many pharmaceutical companies offer discounts, rebates, or financial aid to eligible patients.
- Advocate for Policy Change – Engaging with local representatives and healthcare advocacy groups can help push for necessary reforms.
A Family’s Mission for Change
For Cole’s parents, the fight for justice extends beyond their personal loss. They are determined to ensure that no other family experiences a similar tragedy.
“Our hope is that this lawsuit and Cole’s story will lead to policy changes, ensuring that patients never have to choose between affordability and their health,” said the family’s attorney.
They encourage raising awareness, supporting healthcare transparency initiatives, and standing with organizations that fight for affordable medication access.
Final Thoughts: A Tragedy That Calls for Reform
Cole Schmidtknecht’s story is a heartbreaking example of the real-world consequences of rising medication costs. His case has ignited conversations about patient rights, healthcare policies, and the responsibility of pharmaceutical companies and insurance providers.
While nothing can undo this tragic loss, advocacy and legal action may help prevent similar situations in the future. It is crucial to continue the conversation, support policy changes, and push for a healthcare system that prioritizes patients over profits.
As the debate over medication affordability continues, Cole’s story stands as a powerful call to action—one that reminds us of the importance of access to life-saving treatments for all individuals, regardless of financial circumstances.
