the Voice of
The Communist League of Revolutionary Workers–Internationalist
“The emancipation of the working class will only be achieved by the working class itself.”
— Karl Marx
the Voice of
The Communist League of Revolutionary Workers–Internationalist
“The emancipation of the working class will only be achieved by the working class itself.”
— Karl Marx
Jun 23, 2025
On January 10, 2024, 22-year-old Cole Schmidtknecht, at a Walgreens counter in Appleton, Wisconsin, asked for a refill of the inhaler prescribed by his doctor to prevent asthma attacks. The pharmacy informed him that his UnitedHealthcare insurance no longer covers his medication. Previously, Cole used to pay between $35 and $67 at the same counter during the deductible phase of his insurance plan. Walgreens told him that the current price of his medicine is $540 if he wishes to purchase it.
Stunned, Cole left the pharmacy with a rescue inhaler for quick relief from mild asthma attacks once they start, not with the inhaler he actually needed to prevent asthma attacks from happening. Cole, who works as a truck center employee with self-insurance, could not afford this sky-high out-of-pocket cost.
Five days later, Cole had a severe asthma attack, stopped breathing, and collapsed. He never regained consciousness and died. The empty emergency inhaler was found next to him.
Neither Walgreens nor UnitedHealthcare notified Cole’s doctor about this significant price change imposed by these companies through their covert overnight decisions.
Decisions by so-called pharmacy benefit managers (PBMs), which many of us don’t know, are responsible for the spike in prices of medications like Cole’s inhaler, on top of those decisions made by drug manufacturers. PBMs are essentially middlemen between drug manufacturers, pharmacies, and insurers, controlling the drug supply chain. Without PBMs, pharmacies cannot purchase drugs directly from drug manufacturers and supply them to patients.
PBMs secure price discounts through rebates from drug manufacturers. But these discounts never trickle down to patients. Instead, PBMs pocket these rebates. Since higher drug prices and higher rebates allow such drugs to inflate their profits, PBMs switch from one less profitable drug to another, more profitable drug, overnight. That is precisely what happened to Cole’s asthma medication.
Because PBMs became enormous profit centers over time through such drug price manipulations, the health insurance companies acquired them. Today, three massive corporations—CVS Health (with its PBM, Caremark), Cigna (with its PBM, Express Scripts), and UnitedHealth Group (with its PBM, Optum Rx)—control 80% of the drug supply chain.
As a result, these middlemen have eventually become more profitable setups than those selling insurance or drugs. CVS’s Caremark PBM division generates more revenue than CVS’s nearly 10,000 retail stores. Cigna’s Express Scripts PBM division is far bigger and more profitable than its insurance operations. These companies create billions of dollars of profits out of this thin-air scheme by doing nothing but manipulating the drug prices.
As Cole’s father, Bill Schmidtknecht, said, “It’s insane that it’s happening in America. It’s not broken. It’s designed to work this way. It’s just hurting us.”
This young worker, Cole Schmidtknecht, would be alive today if the healthcare system were not driven solely by profit.