Moby got told,
you know, just simply that he would
never wake up.
Bill and Shannon Schmidnik 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 Cole 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 twenty two year old laying in
that hospital just days earlier
was happy and healthy.
Bill and Shannon were mystified.
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.
Cole had had asthma his whole life.
He was on a great medication 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 Cole
didn't have his medication.
I I will never forget that day.
Their quest for answers began as
grieving parents.
More than a year later, they retell
Cole's story, hoping for change.
We always felt there was something
that was unanswered.
The little they did know 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 five hundred dollars.
And we were like, No, no, no,
no, there has to be like something
something happened.
Like he didn't give
Both Cole and his father 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.
Pocket.
I will never forget that, leaving
that pharmacy and being like,
Oh my God, th this
is what happened to Cole.
Yeah.
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
Schmidtnecks 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 gotta figure
this out. You're not leaving here
with nothing for for him, for Bill.
While no one can know for sure what
happened to Cole at the pharmacy
that day, many, including
Bill's pharmacist, are convinced.
Honestly, she believes this is what
contributed to Cole's death was the
fact 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.
As you could tell, he
was the love of our life.
One day when him and I were laying
in the yard, looking
up at the sky, we looked at me
and said, Grandpa,
when you hit the habit,
would you send me a seat right here?
In March, Senate President Mary
Felskowski reintroduced
legislation that she and the
Schmidtniks believe could have
helped Cole get his medication.
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 Coles Act.
This is the third time the multi
pronged legislation has been
authored.
What happened with the first PBM
bill.
It got really stripped down in the
assembly. We're not gonna allow that
to happen this time around.
We are gonna pass meaningful
legislation.
One part of the bill 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.
We're gonna 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.
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.
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 healthcare 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 United
Health Group's Optim RX,
CVS's CAREMARC, and Cigna's
Express Scripts increased prices
hundreds or thousands of times
over, putting seven point three
billion dollars back into their
pockets from twenty seventeen
to twenty twenty two.
Amid a complex system,
Cole's parents believe more
should have been done.
How will this bill have saved coal?
I'm gonna defer to Cole's dad for
that.
The reality is, any
portion of a bill
that would prevent the slowdown
at the pharmacy counter.
Or so many had he done this or co
w haddy 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 cann
happen. This cannot happen to
another family.
Reporting from Poignette, I'm
Marissa Wochik for here and now.