A young man died after the health plan copay on his asthma inhaler was jacked up to beyond what he could afford. This story has made the rounds of the news lately, including The Washington Post (gated). The pharmacy benefit manager (PBM) responsible for the price increase was Optum, owned by… you guessed it, UnitedHealthcare.
It is always unfortunate when someone dies unnecessarily. When that person is young and in otherwise good health it is especially sad. He had his whole life ahead of him.
Cole Schmidtknecht, 22, couldn’t pay for his daily inhaler due to the “prohibitively expensive” price increase, but then he died of an asthma attack, per a lawsuit filed by his parents.
Cole Schmidtknecht, 22, had a lifelong struggle with asthma, according to the lawsuit filed by Shanon and William Schmidtknecht, of Poynette, Wisc. He managed his symptoms with Advair Diskus — the brand name for fluticasone and salmeterol, medications that help control the symptoms of asthma when taken daily. GSK, the manufacturer of Advair, is not named in the lawsuit.
Cole’s prescription had been covered under his insurance, Optum Rx, which is owned by UnitedHealth Group, the lawsuit alleges. Previously the medication had cost no more than $66.86 (without deductible) and $35 (with deductible).
However, on Jan. 10, 2024, when Cole arrived at his usual Walgreens pharmacy, the suit alleges that he was told his medication was no longer covered and he needed to pay out-of-pocket a total cost of $539.19.
I do not want to downplay a man’s death or his loved one’s suffering. Yet, I wonder why he did not talk to the pharmacist when he felt blindsided by the price increase? The generic version is only $112.81 at Walgreens using a GoodRx coupon. Indeed, with a quick call to his doctor he could have had his prescription transferred to CVS, where it would have cost $47.42 with a special GoodRx coupon. For that matter, I suspect Optum would have covered the generic version or a competing drug.
Why would a PBM jack up cost sharing on an inhaler like the Advair Diskus from $35 to $539? I do not have a definitive answer, but I suspect it was to steer patients away from the high-priced name brand drug to a generic costing a fraction of the original. The Advair Diskus is popular. Not only do the active ingredients work well, but so does the delivery system (i.e., the diskus).
According to the lawsuit, Optum Rx says Walgreens should have contacted Cole’s doctor for a covered alternative, but “did not follow these instructions.”
Cole was also allegedly not provided with a “free or discounted” inhaler to use while he reached out to his provider. Instead, the suit alleges Walgreens “further told Cole that there were no cheaper alternatives or generic medications available.”
More questions arose when the young man’s medical claims history showed five days before he died he filled a prescription for a generic Albuterol “rescue” inhaler to stop attacks while they’re happening. This was presumably filled when he declined to pay for the Advair Diskus at Walgreens.
The man’s parents are suing both Optum and Walgreens, alleging their business practices are “grievous and outrageous.” Yet, another thought comes to mind. This is a prime example of why patients need to take charge of their own health care and not be passive patients. People who will scan the sales circulars and drive across town to save $1 on a carton of milk or eggs often do not investigate cheaper alternatives for the drugs they take. They often do not ask questions or discuss alternatives. It is probably because they do not realize they can, or do not know how.
I am the person in my family who picks up 90% of our prescriptions. I suspect Mr. Schmidtknecht spoke with a pharmacy technician. An actual pharmacist could probably have walked him through the process and got him what he needed. When in doubt, demand to speak with a pharmacist. In health care it is pays to be an active consumer. Usually, it will save you money. On extremely rare occasions, it may even save your life.
- Read more at: 22-Year-Old Dies of Asthma Attack, Parents Allege He Was Unable to Afford Meds
- Washington Post: Wisconsin man dies of asthma attack after inhaler cost skyrockets
- Kaiser Health News: How Do You Deal With Wild Drug Prices?
Given the risk of death without an inhaler, the insurer should have made a more significant effort to offer alternatives…a letter to the insured, even a phone call to the insured, a letter to the pharmacy, but something!!