Background: Cole Schmidtknecht (Patient Protector). Inset: Bil Schmidtknecht, Shanon Schmidtknecht (Patient Protector).
A federal court has been asked by the company held responsible for the tragic death of a young man in Wisconsin, who passed away due to an asthma attack following a significant increase in his medication price, to dismiss the allegations brought forth by the family.
The lawsuit, initiated by Shanon and William “Bil” Schmidtknecht, asserts that their 22-year-old son Cole Schmidtknecht’s death was a consequence of negligent and unlawful decisions made by OptumRx – the pharmacy benefit manager for Cole’s health insurance.
Cole, who had been dealing with chronic asthma since a young age, relied on a daily regimen of the corticosteroid inhaler Advair Diskus to manage his health and avoid asthma episodes. The family revealed that Cole’s employer-provided health insurance, administered through the United Health-OptumRx Plan, used to cover the medication at a cost between $35 and $66.86 out-of-pocket. Nonetheless, in a sudden turn of events, Cole was informed in January 2024 by a Walgreens pharmacist that the price of his prescription had surged to $539.19.
According to the lawsuit, Cole was unable to afford the enormous out-of-pocket cost and opted to go without the medication for several days, during which he suffered a fatal asthma attack.
Cole’s parents sued both Walgreens and pharmacy benefit manager OptumRx, alleging that OptumRx forces patients to fill prescriptions with expensive brand-name drugs when cheaper alternatives exist. They also alleged that OptumRx sets artificial requirements whereby patients are required to try more expensive drugs before cheaper alternatives — all for financial gain. They argued that the practice is illegal under Wisconsin law, which would have required OptumRx to provide Cole a 30-day notice of the change, thereby allowing Cole time to request an appropriate substitute medication.
OptumRx filed a 38-page motion to dismiss the claims against it on Feb. 14 in which it said that the company “expresses its deepest sympathies” over Cole’s “heartbreaking” death, but argued that federal law does not allow the family to bring the claims set out in the filing. The company argued that the federal Employee Retirement Income Security Act of 1974 (ERISA) provides a “broad preemption” that prevents state law from imposing liability on employee benefit plans. ERISA is a federal statute that sets minimum standards for most voluntarily established retirement and health plans in private industry to provide protection for individuals in these plans. The law also protects employers and plan administrators from many state law claims related to benefit plans.
In addition to the procedural argument, OptumRx also argued that the family’s lawsuit presents “an incomplete picture” of the true circumstances surrounding Cole’s attempt to fill his prescription. According to the defense’s filing, Cole had not refilled his prescription for Advair Diskus since April 5, 2022 — nearly two years prior to the Walgreens incident. Further, OptumRx argued, the complaint failed to mention any other medications Cole may have been offered on the day in question, despite plaintiffs having made public statements that Cole was given Albuterol as an emergency medication.
The case is proceeding before U.S. District Judge Byron Browning Conway, a Joe Biden appointee.
Counsel for the parties did not immediately respond to request for comment.
You can read the full filing from OptumRX here.
