Where is flu, COVID surging? Here’s where people are filling prescriptions for Tamiflu, Paxlovid, and more

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Where is flu, COVID surging? Here’s where people are filling prescriptions for Tamiflu, Paxlovid, and more

GoodRx, a platform for medication savings, is tracking prescription fills for medications that treat seasonal viral respiratory infections. The tracker includes fills for:

Tamiflu (oseltamivir) for influenza
Paxlovid and molnupiravir for COVID-19
Antibiotics, such as amoxicillin, for secondary bacterial infections associated with respiratory syncytial virus (RSV) and whooping cough

Key takeaways:

These fills give insight into rates of infections and how they’re being treated.
Tamiflu fills typically peak between December and February. A jump in fills before December may indicate an early flu season. High fills in late spring could signal an extended flu season.
Paxlovid and molnupiravir fills may spike during the late summer and winter, mirroring the back-to-school season's impact on COVID-19 transmission.
Fills for pediatric antibiotics associated with respiratory syncytial virus (RSV) and whooping cough typically peak during the fall and winter, with return-to-school schedules.
Coverage for COVID-19, flu, and RSV vaccines remains high across insurance types but varies by channel. Commercial plans generally have more people lacking coverage than Medicare and Medicaid, which offer broader, no-cost access. Cash prices also vary for those paying out of pocket, highlighting ongoing affordability challenges.

Why track treatment fills?

Fall and winter are the height of cold and flu season. During these months, the viruses that cause common respiratory infections, such as influenza, coronavirus, and RSV, spread widely. In many cases, these infections don’t cause serious illness. But they can be deadly for children, older adults, and people with weakened immune systems.

Typically, the CDC actively monitors these viruses through tools such as the FluView for influenza, the COVID-19 Data Tracker, and the Respiratory Syncytial Virus Surveillance system. These tools help Americans understand the risk of contracting these viruses. But they don’t indicate how people are treating these infections.

To this end, GoodRx Research has developed several tracking tools to monitor prescription fills for medications that treat these respiratory infections and provide insights into:

Whether Americans are taking (or not taking) FDA-approved treatments for the flu, COVID-19, or secondary bacterial infections associated with RSV and whooping cough
Whether healthcare professionals are prescribing these medications at rates in line with CDC-reported infection rates
How treatment patterns for the current cold and flu seasons compare to prior seasons

These tools can be used along with the CDC’s viral surveillance data and provide insight into national treatment trends.

Making sense of Tamiflu (oseltamivir) fills for flu treatment

Tamiflu (oseltamivir) is one of the key antiviral medications recommended by the CDC to treat influenza. It can also be used to prevent the flu if someone has had close contact with another person who tested positive for the flu. Tamiflu is usually prescribed for five days to help reduce the severity of symptoms and shorten recovery time.

The GoodRx Research Tracker began reporting data at the start of the flu season, which typically occurs during the 40th week of the year and usually falls in the first week of October. The flu season typically peaks between December (week 48) and February (week 7). The weekly numbering system restarts in the first week of January.

What can we expect?

Based on previous years, GoodRx expects Tamiflu fills to increase between December and May. There’s usually a peak in fills around February and March. For example, in the 2023-2024 season, Tamiflu fill rates significantly increased in mid-December and peaked in February. Unlike past years, that season lasted into May, suggesting a longer flu season.

An early uptick between October (week 40) and December (week 48), relative to prior years, may suggest an early influenza season. This happened in the 2022-2023 flu season. High prescription fills between April (week 12) and June (week 22) may suggest a late, sustained flu season. And high Tamiflu fills between June (week 22) and September (week 37) may suggest an unusual off season. This could be due to lower flu vaccination rates earlier in the year or new influenza variants not accounted for in the flu vaccine design.

Making sense of Paxlovid (nirmatrelvir / ritonavir) and Lagevrio (molnupiravir) fills for COVID-19 treatment

Paxlovid (nirmatrelvir / ritonavir) and molnupiravir are oral antiviral medications. They’re used to treat people with mild-to-moderate COVID-19 infections or who are at high risk of developing severe infections. You should start taking these medications within five days of first having symptoms.

GoodRx tracked the national fill rate over a 52- to 53-week period, starting at week 40 for Paxlovid and molnupiravir.

What can we expect?

Unlike the common cold and the flu, researchers are still learning about COVID-19 seasonal patterns. And COVID-19 medications are relatively new.

Previous patterns suggest that COVID-19 rates may increase during the late fall and winter months and again in late summer to early fall. If that’s the case, there should be an increase in Paxlovid and molnupiravir fills during this time. That appeared to happen in the 2022-2023 and 2023-2024 seasons. Fills for Paxlovid increased in the winter, tapered off in the early spring, and went up again during the late summer as school resumed.

The 2021-2022 seasonal pattern was a bit different from these seasons. COVID-19 medications were first approved during this season, and their use surged as they entered the market between April (week 16) and September (week 36).

Making sense of pediatric antibiotic fills

During fall and winter, several contagious respiratory infections commonly affect children. These include RSV, influenza, other seasonal viruses, and bacterial infections, such as whooping cough.

These infections can lead to cold-like symptoms that usually go away on their own within seven to 10 days. However, secondary bacterial infections can develop on top of viral infection, and these may require antibiotic treatment.

Healthcare professionals may prescribe antibiotics like amoxicillin in specific situations:

To treat a bacterial infection that arose during a viral infection, such as RSV or the flu
When it's unclear whether an infection is viral or bacterial

GoodRx tracked oral solution antibiotics rather than FDA-approved treatments for viral infections for two key reasons:

Oral solution antibiotics are commonly used in children to treat severe complications from secondary bacterial infections. And their fill trends should resemble surveillance data for seasonal infections.
Data on specific FDA-approved treatments for viral infections may be limited, especially for newer medications.

What can we expect?

Many respiratory infections follow a seasonal pattern. They peak as children enter school, and during the winter, as the weather gets colder and people spend more time indoors. So there should be an increase in antibiotics during these periods.

The chart below illustrates that antibiotic prescription fills often mirror seasonal infection trends, particularly for oral solution antibiotics. Fills typically surge between December and February, during the peak of these infections, and taper off by late spring.

States hit hardest by cold, flu, and COVID-19

Cold and flu season may hit different geographic regions at different times. The map below offers a visual snapshot of where prescription activity for influenza, COVID-19, and RSV treatments is higher or lower relative to the national average. Darker shades indicate higher fill rates, meaning prescriptions for that treatment were filled more often in those states. Lighter shades indicate lower fill rates, suggesting fewer fills relative to the national average.

What can we expect?

In general, higher fill rates may reflect increased infection activity, since more people may be seeking treatment during a period of higher illness circulation. However, fill rates can also be influenced by prescribing behavior, testing availability, or local treatment access. For instance, a higher fill rate relative to the national average in one state could reflect more proactive prescribing by healthcare professionals rather than a higher rate of infection itself.

Making sense of insurance coverage for seasonal treatments

Access to vaccines and antivirals for flu, COVID-19, and RSV often depends on insurance coverage. Some plans require extra steps like prior authorization. Other plans may not cover these treatments at all — leaving consumers to pay full price.

According to Managed Markets Insight and Technology (MMIT), insurance coverage since 2024 shows modest shifts in vaccine access across all payers:

COVID-19: About 56 million people lacked COVID-19 vaccine coverage in September 2025 (17.7% of plan lives), up slightly from 54.7 million (17.4%) a year earlier.
Flu: Flu vaccine coverage declined by roughly one percentage point from 2024 to 2025.
RSV: RSV vaccine non-coverage improved, falling from about 6.1% to 5.3%. Overall, access remains high across insurance types, with only minor year-over-year fluctuations and continued variability by payer and product type.

Insurers have committed to maintaining coverage for vaccines recommended by ACIP (Advisory Committee on Immunization Practices) through 2026. GoodRx Research will monitor coverage trends monthly for commercial plans, where small shifts can directly affect pharmacy fills and out-of-pocket costs. In contrast, Medicare and Medicaid beneficiaries generally receive these vaccines at no cost.

Read on to see how these trends differ across insurance channels and how they correlate with observed fill patterns.

Commercial insurance

Some commercial plans require extra steps, like prior authorization, while others may not cover these vaccines or antivirals at all — leaving consumers to pay full price.

The chart below shows that as the 2025-2026 cold season begins, about one in 11 commercially insured individuals lacks coverage for flu vaccines, up from 8.2% last year to 8.9% this year. This is an increase of nearly one percentage point, affecting about 1.7 million lives.

By contrast, coverage for RSV and COVID-19 vaccines has improved. The share of people without coverage has declined from 6.1% to 5.3% for RSV and from 6.2% to 4.7% for COVID-19, translating to roughly 1.3 million and 2.6 million fewer people without coverage, respectively — suggesting broader access to these vaccines.

Medicaid

Under federal rules, state Medicaid programs must cover all ACIP-recommended vaccines for both children and adults, with no cost-sharing allowed. However, implementation can vary by state in terms of how quickly coverage is updated after new ACIP recommendations.

This policy framework suggests that Medicaid enrollees are more likely to have consistent vaccine coverage than those in commercial plans, though administrative barriers — such as provider availability — can still affect uptake. However, there remains concern that if ACIP does not recommend a vaccine and the CDC does not adopt that recommendation, Medicaid enrollees may not have coverage for it.

Medicare

Medicare provides vaccine coverage through Part B (for flu, COVID-19, and pneumococcal vaccines) and through Part D (for other vaccines like shingles and RSV).

Since January 2023, the Inflation Reduction Act requires all ACIP-recommended vaccines covered under Part D to be available with no cost-sharing. This means that, in principle, Medicare beneficiaries should face fewer financial barriers to vaccines compared to commercial coverage. However, the division between Part B and Part D may still create some complexity in how vaccines are billed and accessed.

Making sense of cash prices for antivirals and antibiotics

For people without coverage — or those facing delays from insurance restrictions — the retail cost of antivirals and antibiotics can be a major barrier. Prices for a typical Tamiflu course can exceed $100 without insurance, and newer COVID-19 antivirals like Paxlovid can run much higher.

Adding cash price insights shows how out-of-pocket costs shape treatment decisions during cold and flu season.

Here are approximate cash prices for:

RSV vaccine: $369
COVID-19 vaccine: $201
Flu vaccine: $91

How to reduce the risk of contracting a respiratory infection

Some of these medications do not stop viral shedding. That means people who are infected and taking them can still spread the virus. That’s why it's important to protect yourself from infection. Here are some measures you can take:

Get vaccinated. Flu, COVID-19, and RSV vaccines are effective at reducing the length and severity of infection. Medicare and Medicaid cover all recommended vaccines, and most commercial plans also provide coverage, and for uninsured individuals, you can get discounted or even free flu vaccines at some pharmacies.
Wash your hands often. This can keep virus-carrying droplets at bay.
Avoid touching your eyes, nose, and mouth.
Visit your healthcare professional if you feel sick. You can compare telehealth options in your state using GoodRx — and even see someone online through GoodRx Care. The sooner you visit, the sooner you can get the prescription you need.
Stay home if you’re feeling sick or having symptoms, and isolate for the recommended time period based on your respiratory infection.

The CDC guidelines recommend that you can resume regular activities once you haven’t had a fever and your symptoms have been getting better for 24 hours. Keep in mind that people infected with RSV are usually contagious a few days before they have symptoms and can be contagious for three to eight days.

Methodology

Weekly prescription fill rate reporting convention: Prescription fill rate is based on a statistically significant sample of fills at U.S. pharmacies. Data comes from several sources, including pharmacies and insurers, and provides a representative sample of nationwide U.S. prescription medication volume. The fill rate represents the percent total fill for only oral solution amoxicillin over the total number of all fills in the same period. We presented data using the CDC’s weekly influenza reporting system convention, which starts on the 40th week of the year (October) and runs up to the fall of the following year (week 39). We used the average of week 52 and week 1 to add a 53rd week to flu seasons that spanned nonleap years.

Monthly state-level fill rate: Monthly counts of treatment-specific fills were divided by all medication fills in the same period and state to produce fill rate percentages. These rates were then compared to national averages to identify relative differences in treatment activity across states

Monthly commercial share of lives without vaccine coverage: To measure how vaccine coverage changes across the commercial market, we calculated the monthly share of covered lives lacking formulary access to vaccines for COVID-19, influenza, and RSV. Data reflect plan-level coverage reported to MMIT and were aggregated by insurance channel and month to identify changes in access over time. For each vaccine type, the share of “lives without coverage” represents the proportion of insured individuals in commercial and exchange plans whose formularies did not list the vaccine as covered during a given month. These plan-month observations were then weighted by the number of covered lives to produce a representative monthly percentage of commercially insured people without vaccine coverage.

Prescription medications used in study: For weekly prescription fill trends, GoodRx included the following influenza antiviral medications: Tamiflu (oseltamivir), Xofluza, Relenza, Rapivab. For COVID-19, the following medications were used: Paxlovid, molnupiravir, and Lagevrio. For antibiotics, our data only includes oral solution antibiotics indicated for upper respiratory infections and sinus infections, and primarily used in children.

For estimated cash price and formulary coverage analyses, we included the following vaccinations: For influenza vaccination, included products were

Fluarix, Fluzone, Flublok, Flucelvax, Afluria, Flulaval, Fluad, Fluzone High-Dose, and Flumist (including Flumist Quadrivalent). For respiratory syncytial virus (RSV) vaccination, included products were Arexvy, Abrysvo, and Mresvia. For COVID-19 vaccination, included products were Comirnaty, Spikevax, Novavax, and COVID-19 vaccine products marketed without a proprietary name.