Bradley, thank you for your time.
>> Thanks. >> Zach.
>> For decades, the cost of prescription medication has
been ever increasing. At the same time, health coverage
for medication has been decreasing, forcing patients
to make harder decisions about their health. Over the
next few weeks, we bring you RX uncovered, a series from
“Here& Now” producer Marissa Wojcik that dives into the
complex systems driving these trends and the stories
of patients facing life or death choices. Our first
story is about a young man with asthma who suddenly had
to choose between affording his rent or his medicine.
>> Well, we got told, you know, just simply that he
would never wake up. >> Brill and Shanon
Schmidtknecht had just heard the worst news of their
life. >> That all I remember is
collapsing on him and the nurses sliding chairs behind
us. >> Their oldest son, Kohl,
suffered an asthma attack. His roommate rushed him to
the ER and his heart stopped beating two minutes before
they arrived. >> When he arrived at the
hospital, he was lifeless. Yeah. No pulse. They had to
resuscitate him. >> But the prognosis wasn't
good. >> They were no longer
seeing the brain activity. They were no longer seeing
any hope that there would be any type of recovery, that
essentially what we saw laying in the hospital of
our son was all that he would ever be.
>> The 22 year old laying in that hospital just days
earlier was happy and healthy. Bill and Shannon
were mystified. >> Yes. When I grab on to
him, like I just couldn't, you're like, this cannot be
happening. >> In the days that
followed, Bill and Shannon watched their son fulfill an
organ donation before watching him take his final
breath. >> Kohl had had asthma his
whole life. He was on a great that stabilized his
asthma for the past decade or more. So we were like,
this cannot be. >> Still in shock. They
didn't understand how this could have happened and why
Kohl didn't have his medication.
>> I will never forget that day.
>> Their quest for answers began as grieving parents.
More than a year later, they retell Kohl story, hoping
for change. >> We always felt there was
something that was unanswered.
was from Cole's best friend and roommate, who said Cole
did go to the pharmacy days earlier but couldn't get his
asthma medication refilled. >> His roommate had said, I
don't know. We tried to get it a few days ago and he
couldn't afford it. It was like $500 and we were like,
no, no, no, no. There has to be like something, something
happened. Like he didn't give.
managed the same chronic asthma their whole lives.
They used the same prescription inhaler and
they worked for the same company, meaning they had
the same health coverage. >> Probably a few weeks
later, texted her, say, hey, can you swing by the
pharmacy and grab my steroid medicine too?
>> I just remember walking in and she had it written
down on a piece of paper. No longer covered by insurance.
She worked her magic and made a phone call. Even
stayed after they were open and, you know, did what she
had to do to get something for me to take home so that
he had something. >> This was the first
glimpse into what may have happened in the days leading
up to Cole's death. Health coverage from the employer
had changed, and with it, the out-of-pocket cost.
>> They were told specifically as employees
that it would be a seamless transition. Pharmacy
benefits would be seamless. Prescription coverage would
be seamless. >> The unique thing, though,
is we stayed with the same pharmacy benefit manager.
>> What did change without their knowledge was their
prescription benefits formulary. The list of
preferred drugs covered by the health plan. These lists
are compiled of name, brand and generic medications
categorized into tiers. Tier one is the most preferred by
the plan and has the lowest co-pays. The higher the
tier, the more the patient pays out of pocket.
>> I will never forget that leaving that pharmacy and
being like, oh my God, this is what happened to Cole.
>> The preventative asthma medication that Cole relied
upon was moved to a higher tier that he suddenly could
not afford. >> We always assume that he
kind of ran some life choices and said, rent or
this, and thought he could do without it. Five days
after that, he texted me that he was having a hard
time breathing. >> The parallel details
around Bill and Cole's condition, medication and
health plan helped the Schmidtknecht understand how
Cole's pharmacy visit differed from Bill's.
>> The difference is he didn't have this pharmacist
or any caring independent pharmacist or whomever to
stop for five seconds. >> Bill's pharmacist made
sure he got the life saving medication he needed.
>> She was like, so we got to figure this out. You're
not leaving here with nothing for him, for Bill.
>> While no one can know for sure what happened to Cole
at the pharmacy that day, many, including bills
pharmacist, are convinced. >> Honestly, she believes
this is what contributed to that he didn't get his
medicine. Walking out of the pharmacy. You know, she she
can't make that judgment for sure, but she felt that way.
>> And you could tell he was the love of her life. One
day, him and I were laying in the yard looking up at
the sky. He looked at me and said, grandpa, when you eat
the heaven, would you save me a seat by you?
>> In March, Senate President Mary Felzkowski
reintroduced legislation that she and the
Schmidtknecht believe could medication. At some point,
somebody has to say enough is enough and put some
guardrails around this. >> The bill contains a
number of measures aimed at protecting independent
pharmacies and adding regulations against pharmacy
benefit managers, or PBMs. >> PBMs are essentially a
middleman hired by insurance companies to manage patient
prescription drug benefit programs. And they're
actually adversely driving up the cost of drugs and
controlling whether or not you get the medication
that's been prescribed to you.
>> Newly dubbed Cole's Act, this is the third time the
multi-pronged legislation has been authored.
>> I watched what happened with the first PBM bill. It
got really stripped down in the Assembly. We're not
going to allow that to happen this time around. We
are going to pass meaningful legislation.
deals specifically with drug formularies, saying a plan
cannot change a drug's tier except at the time of
coverage renewal. Historically, employer and
insurance groups have opposed this legislation,
fearing it will increase costs.
>> Marketplace events occur throughout throughout the
year that impact the price of prescription drugs by
implementing a frozen formulary. Payers and plans
will be limited in their ability to take advantage of
new reduced prices. Generic. >> We're going to work very
hard on showing them through data from other states that
have allowed that have the same legislation, where it's
actually lowered the cost of health care.
>> I can't believe it's been almost a year that he's gone.
Yeah, exactly. >> One year after Cole's
passing, his parents filed a negligence lawsuit against
the pharmacy benefit manager and the chain pharmacy where
Cole went to try and pick up his inhaler. The complaint
says no notification went out that the formulary had
changed, and the pharmacist should have offered a
generic alternative. It lists a number of points of
failure, many of which violate Wisconsin law. In a
motion to dismiss, the PBM argues that because Cole's
health plan is what's called self-funded, these types of
employer sponsored benefits are not technically health
insurance. They're largely not subject to state law,
and exclusively a federal concern.
>> We can't keep waiting for Washington. My constituents
can't afford to keep waiting for Washington on a number
of things. And I believe in states rights. And it's time
that the states need to step up. You know, we have the
fifth highest health care costs in the nation. And our
quality does not reflect that.
>> Congressional committees and federal agencies have
been sounding some alarm on practices rampant across the
industry. In January, the Federal Trade Commission
released its latest report investigating the top three
PBM companies for inflating drug prices, saying
UnitedHealth group's Optumrx, CVS Caremark and Cigna
Express Scripts increased prices hundreds or thousands
of times over, putting $7.3 billion back into their
pockets from 2017 to 2022. Amid a complex system.
Cole's parents believe more should have been done.
>> How will this bill have saved Cole?
>> I'm going to defer to Cole's dad for that.
>> The reality is, any portion of a bill that would
prevent the slowdown at the pharmacy counter. There's so
many Harry Dunn this. Or had he went to this type of
pharmacy, the ultimate thing, no matter what
happens, it was totally preventable. I mean, like,
it was preventable. Please don't let another parent
stand where we are today. >> We've just taken a
totally different look at so many things in life. It's
all because this cannot happen. This cannot happen
to another family. >> Reporting from Poynette.