A Preventable Tragedy: How a Broken Drug Pricing System Cost a Young Man His Life

When 22-year-old Cole Schmidtknecht tried to refill his asthma medication in Appleton, Wisconsin, he was stunned to find that the inhaler, previously under $70, now cost over $500. Unable to afford it, Cole left the pharmacy with only a rescue inhaler—designed for emergencies, not prevention.

Five days later, he suffered a severe asthma attack, stopped breathing, and never regained consciousness. He died shortly after. His parents, Bil and Shanon, were devastated and outraged.

Behind the price spike was a pharmacy benefit manager (PBM) called Optum Rx, which had removed Cole’s inhaler from the insurance formulary without proper notice. PBMs—largely unknown to the public—quietly decide which drugs are covered by insurance, often based on profit-driven rebate deals with drugmakers.

The Schmidtknechts are now suing Optum Rx and Walgreens, alleging they failed to notify Cole or his doctor of cheaper alternatives. According to them, Cole received no help finding an affordable solution.

Experts say this case reflects a broader issue: PBMs operate in secrecy, controlling medication access for millions of Americans. Just three PBMs handle 80% of U.S. prescriptions. A recent FTC report revealed these companies have driven up costs for life-saving drugs by billions.

Cole’s parents are now fighting for change, pushing legislation that would require a 90-day warning for formulary changes.

“He had his whole life ahead of him,” Shanon said. “And it was so preventable.”

To honor Cole, his parents bear matching tattoos of his, a daily reminder of their mission: justice for their son—and for every family navigating an opaque and profit-first system.