OBJECTIVES: We assessed the relationship between individual characteristics and 
receipt of oseltamivir (Tamiflu) in the United States during the H1N1 pandemic 
and other flu seasons.
METHODS: In a cohort of individuals enrolled in pharmacy benefit plans, we used 
a multivariate logistic regression model to measure associations between 
subscriber characteristics and filling a prescription for oseltamivir during 3 
flu seasons (October 2006-May 2007, October 2007-May 2008, and October 2008-May 
2010). In 19 states with county-level influenza rates reported, we controlled 
for disease burden.
RESULTS: Approximately 56 million subscribers throughout the United States were 
included in 1 or more study periods. During pandemic flu, beneficiaries in the 
highest income category had 97% greater odds of receiving oseltamivir than those 
in the lowest category (P < .001). After we controlled for disease burden, 
subscribers in the 2 highest income categories had 2.18 and 1.72 times the odds 
of receiving oseltamivir compared with those in the lowest category (P < .001 
for both).
CONCLUSIONS: Income was a stronger predictor of oseltamivir receipt than 
prevalence of influenza. These findings corroborate concerns about equity of 
treatment in pandemics, and they call for improved approaches to distributing 
potentially life-saving treatments.