Why people are afraid of universal health care

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Man Dies of Fatal Asthma Attack After Meds Jumped to Over $500, Lawsuit Alleges

Parents' lawsuit alleges PBM violated Wisconsin law by raising cost without valid medical reason

www.medpagetoday.com

A Wisconsin couple is suing Walgreens and a pharmacy benefit manager (PBM), alleging that their son died because he couldn't afford a sudden $500 spike in his asthma medication.

Shanon and William Schmidtknecht, of Poynette, filed their lawsuit in federal court in Milwaukee on Jan. 21, a year to the day that their son Cole died at age 22.

According to the lawsuit, Cole Schmidtknecht suffered from asthma all his life. He managed it with daily inhaler doses of the medication fluticasone propionate/salmeterol.

He stopped at a Walgreens pharmacy in Appleton on Jan. 10, 2024, to refill his prescription and was told the cost had jumped from $66 to $539 out-of-pocket. Unable to afford the new cost, he left the pharmacy without the medication. He tried to manage his condition with his rescue inhaler but suffered a fatal asthma attack days later, according to the lawsuit.


The Schmidtknechts allege that PBM OptumRx violated Wisconsin law by raising the cost of the medication without a valid medical reason and failing to provide 30 days' advance notice of drug price increases.

 

[Emily Lake]

PBMs have a lot of bullshit going on. This doesn't surprise me at all. Last year, my anti-seizure drug (which as been generic for almost 20 years) went from ~$30 for a 90 day supply to $390. If I *don't* use my insurance, and just use GoodRx, it's like $35. It's abusive, and it's another area where insurance companies have little way to control those costs. It's especially perverse when you realize that this PBM is owned by United Health Group. The vertical integration in the health care system is a serious problem.

 

[blastula]

Kotek denounces apparent targeted shooting at SAIF executive's home

As the Lake Oswego Police Department continues to seek information regarding a shooting at the home of Chip Terhune, the CEO of the nonprofit workers’ compensation insurer SAIF Corp., Gov.

www.portlandtribune.com

 

[Loren Pechtel]

PBMs have a lot of bullshit going on. This doesn't surprise me at all. Last year, my anti-seizure drug (which as been generic for almost 20 years) went from ~$30 for a 90 day supply to $390. If I *don't* use my insurance, and just use GoodRx, it's like $35. It's abusive, and it's another area where insurance companies have little way to control those costs. It's especially perverse when you realize that this PBM is owned by United Health Group. The vertical integration in the health care system is a serious problem.

I haven't seen anything that bad but there's definitely a big problem there. This is what you get with a wide open field of "negotiating drug prices". It ends up being a major case of robbing Peter to pay Paul, as well as things like my wife's thyroid medicine is specifically labeled telling patients not to change suppliers (it's sufficiently dose sensitive that going from brand X to brand Y might not produce the right result), yet she's up to IIRC 3 changes now. And it's one that could be fixed pretty easily:

No negotiation is permitted. If you want to sell to US consumers you offer US consumers the same best price. No rebates, no deals, no formularies, you can't change prices in opposite directions with any 90 day window unless you retroactively lower any sales made within that window so as to make it not moving in opposite directions. This is specifically not exclusive--everyone else should be encouraged to do the same thing.

But why are they suing Walgreens? It's the PBM that killed the guy.

 

[Loren Pechtel]

The absence of detail in what happened My desire to handwave away anything that doesn't support my beliefs makes me suspicious.

FTFY.

Stories that omit important aspects are often not very accurate.

Yes. That's why I object to your handwaving them away.

You need to pay more attention.

You're agreeing that I'm right in dismissing the case for absence of detail.

 

[Emily Lake]

But why are they suing Walgreens? It's the PBM that killed the guy.

Misplaced anger and the fact that to most people, PBMs are invisible. Most people aren't going to make a distinction between the place they purchase their medicine and the company that sets the prices on those medicines. And most people have no idea that the PBM isn't just their insurance company.