It's been hard enough to find H1N1 virus vaccine for kids. But if they get the flu, it also can be tough to get a prescription filled for the drug used to treat it.

The early and unexpected H1N1 virus outbreak, along with kids' vulnerability to the illness, has created a national shortage of the liquid form of the anti-viral drug Tamiflu. The liquid drug is prescribed to small children and anyone else who has trouble swallowing pills.

The federal government last month released its last 234,000 doses of liquid Tamiflu from a national stockpile. More supplies from Roche, the manufacturer, are not expected until January.

Because the H1N1 virus qualifies as a national health emergency, the U.S. Food and Drug Administration issued an emergency use authorization for Tamiflu, which relaxes some of the prescription rules and allows some expired but still effective products to be used.

Health officials also have encouraged pharmacists to open Tamiflu capsules and mix the powder inside with a flavored syrup to create a liquid form. But the compounding process adds about 30 minutes to the prescription filling process and adds about $50 to the cost, pharmacists said.

In Bismarck, many pharmacies have Tamiflu available in capsules and make the suspension through compounding.

But insurance companies don't always want to pay for it.

A survey of 100 pharmacists found that some prescription plan providers have balked at approving costs for the liquid Tamiflu mixes. The prescription can cost about $100 out-of-pocket.

Three out of five pharmacists surveyed reported having problems getting the approvals for making the liquid, according to the National Community Pharmacists Association.

The pharmacy group sent a letter recently to pharmaceutical benefits companies calling for a relaxation of billing policies on Tamiflu mixes "so that folks don't have the anxiety of trying to get this medication or being put through a bunch of hoops to get this medication for a sick child," said Douglas Hoey, the pharmacy group's chief operating officer.

Children are at higher risk for catching the H1N1 virus and developing serious complications. There have been 179 reported deaths from the H1N1 virus of U.S. children since April. Between 50 and 100 children die of seasonal flu each year.

While most people who catch the H1N1 virus won't need Tamiflu, the drug can be taken within 48 hours after symptoms start to reduce the severity of the illness. The drug is typically taken for five days.

It's not ideal, but it works, according to the federal Centers for Disease Control and Prevention. The agency took the unusual step of teaching parents how to break down the Tamiflu pills themselves. In step-by-step instructions on its Web site, the CDC explains that chocolate syrup is best for mixing with the powder from the pills.

Luckily, some pharmacists still add their own spoonfuls of sugar.