tetano
Editor, Senior Moderator
Open Forum Infect Dis
. 2026 Jul 22;13(7)
fag439.
doi: 10.1093/ofid/ofag439. eCollection 2026 Jul.
Antiviral Dispensing for Influenza Outpatients Younger Than 65 Years With Comorbidities: A Retrospective Cohort Study
Grazia Grace Mirabito[SUP] 1 [/SUP], Svetlana Masalovich[SUP] 1 [/SUP], Timothy M Uyeki[SUP] 1 [/SUP], Carrie Reed[SUP] 1 [/SUP], Shikha Garg[SUP] 1 [/SUP], Katherine Adams[SUP] 1 [/SUP]
Affiliations
Background: Real-world evidence on antiviral dispensing for influenza outpatients with underlying medical conditions (UMCs) is limited. We characterized dispensing among influenza outpatients aged <65 years with UMCs, comparing commercial and Medicaid coverage.
Methods: We used outpatient encounter claims from the US MarketScan Commercial and Medicaid databases during October-April of the 2018-2019 through 2023-2024 influenza seasons and October-December 2024-2025. Eligible encounters included patients aged <65 years with a clinical influenza diagnosis, ≥1 UMC, and ≥12 months of continuous enrollment before diagnosis. Antiviral treatment was defined as dispensing of oseltamivir, peramivir, zanamivir, or baloxavir within 7 days of the encounter. We described demographic, clinical, and care-seeking characteristics and evaluated overall and same-day dispensing by insurance type.
Results: Among 549 424 encounters, 268 463 (48.9%) were commercially insured (median age 19 years [interquartile range, IQR, 8-44]) and 280 961 (51.1%) were Medicaid insured (median age 10 years [IQR 5-18]). Chronic pulmonary disease was the most common UMC (88.0% and 81.8%). Antivirals were dispensed in 54.2% (commercial) and 53.7% (Medicaid) of encounters, almost exclusively oseltamivir. Same-day dispensing occurred in 91.1% of commercial and 81.4% of Medicaid encounters. Overall dispensing was lowest among patients with emergency department encounters or multiple outpatient visits; same-day dispensing was lowest among those with multiple UMCs, emergency department encounters, or multiple visits. Dispensing increased with age in commercial encounters but declined among adults with Medicaid.
Conclusions: About half of higher-risk influenza outpatients received antivirals. Overall dispensing was similar by insurance type, but Medicaid patients and those with multiple UMCs had greater delays.
Keywords: MarketScan; antiviral; influenza; oseltamivir; outpatient claims.
. 2026 Jul 22;13(7)
fag439.doi: 10.1093/ofid/ofag439. eCollection 2026 Jul.
Antiviral Dispensing for Influenza Outpatients Younger Than 65 Years With Comorbidities: A Retrospective Cohort Study
Grazia Grace Mirabito[SUP] 1 [/SUP], Svetlana Masalovich[SUP] 1 [/SUP], Timothy M Uyeki[SUP] 1 [/SUP], Carrie Reed[SUP] 1 [/SUP], Shikha Garg[SUP] 1 [/SUP], Katherine Adams[SUP] 1 [/SUP]
Affiliations
- PMID: 42494832
- PMCID: PMC13392465
- DOI: 10.1093/ofid/ofag439
Background: Real-world evidence on antiviral dispensing for influenza outpatients with underlying medical conditions (UMCs) is limited. We characterized dispensing among influenza outpatients aged <65 years with UMCs, comparing commercial and Medicaid coverage.
Methods: We used outpatient encounter claims from the US MarketScan Commercial and Medicaid databases during October-April of the 2018-2019 through 2023-2024 influenza seasons and October-December 2024-2025. Eligible encounters included patients aged <65 years with a clinical influenza diagnosis, ≥1 UMC, and ≥12 months of continuous enrollment before diagnosis. Antiviral treatment was defined as dispensing of oseltamivir, peramivir, zanamivir, or baloxavir within 7 days of the encounter. We described demographic, clinical, and care-seeking characteristics and evaluated overall and same-day dispensing by insurance type.
Results: Among 549 424 encounters, 268 463 (48.9%) were commercially insured (median age 19 years [interquartile range, IQR, 8-44]) and 280 961 (51.1%) were Medicaid insured (median age 10 years [IQR 5-18]). Chronic pulmonary disease was the most common UMC (88.0% and 81.8%). Antivirals were dispensed in 54.2% (commercial) and 53.7% (Medicaid) of encounters, almost exclusively oseltamivir. Same-day dispensing occurred in 91.1% of commercial and 81.4% of Medicaid encounters. Overall dispensing was lowest among patients with emergency department encounters or multiple outpatient visits; same-day dispensing was lowest among those with multiple UMCs, emergency department encounters, or multiple visits. Dispensing increased with age in commercial encounters but declined among adults with Medicaid.
Conclusions: About half of higher-risk influenza outpatients received antivirals. Overall dispensing was similar by insurance type, but Medicaid patients and those with multiple UMCs had greater delays.
Keywords: MarketScan; antiviral; influenza; oseltamivir; outpatient claims.