A Wisconsin family has filed a lawsuit against Optum Rx and Walgreens following a pharmacy-benefit change that increased the cost of their son's asthma inhaler from under $70 to more than $500. This price hike left him without his maintenance medication before he suffered a fatal asthma attack.
According to NBC, Cole Schmidtknecht, 22, visited a Walgreens in Appleton, Wisconsin, to refill his daily asthma maintenance inhaler. He was informed that the price had risen from approximately $66 to $539 due to a change in pharmacy benefits. Schmidtknecht left without the medication and relied solely on a rescue inhaler. Days later, he died following a severe asthma attack. The family's lawsuit names Optum Rx and Walgreens, alleging that the Pharmacy Benefit Manager (PBM)-driven formulary change prevented him from accessing his controller medication.
Pharmacy benefit managers are companies hired by insurers and large employers to manage prescription-drug benefits. They act as intermediaries between drugmakers, pharmacies, and health plans, determining which drugs are covered, processing claims, setting pharmacy reimbursements, and negotiating manufacturer rebates. Their decisions significantly impact patients' access to medications and their costs at the pharmacy counter.
A 2025 Federal Trade Commission (FTC) report highlighted that the "Big 3" PBMs—CVS Caremark, Express Scripts, and Optum Rx—marked up many specialty and generic drugs at their own pharmacies by substantial percentages. From 2017 to 2022, these markups generated over $7.3 billion in revenue above acquisition costs and roughly $1.4 billion through spread pricing.
The U.S. Government Accountability Office reported that private health plans spent nearly $152 billion on retail prescription drugs in 2021—a rise of 18% since 2016. Between 2017 and 2023, all 50 states enacted at least one law aimed at increasing transparency and oversight of PBMs due to growing concerns over practices like rebate retention and spread pricing.
Cole William Schmidtknecht (March 18, 2001–January 21, 2024) was diagnosed with asthma at age one and lived in Wisconsin throughout his life. Known as "Mr. Independent" by his family, he enjoyed asking big questions, gaming competitively, and streaming on Twitch. He eventually returned to Appleton to live independently with his best friend Mitchell while working full-time.
