Vaccine for Girls Raises Thorny Issues

"We're seeing a fairly remarkable uptake of Gardasil," said Rick Haupt of Merck & Co., which reported sales of the vaccine had reached $70 million, exceeding analysts' projections.

Deborah Hager of Perkasie, Pa., immunized her 11-year-old daughter, Rachel, even though she is raising her to be abstinent until marriage.

"I just figured I might as well give it to her now so we know she's protected," Hager said. "Hopefully, she'll believe as we do, but you don't know what's going to happen down the road."

But the vaccine faces significant hurdles, experts say, not the least of which is the price. At $120 a dose, plus doctors' charges, a full three-shot series costs $400 to $500. While many insurance plans are covering the vaccine, others have not yet decided, have not determined how much they will reimburse or have not announced when their reimbursements will begin.

As a result, while many pediatricians are stocking the vaccine, others have delayed ordering it, saying they are unable to pay thousands of dollars without being assured they will recover their costs.

"Nobody is receiving Gardasil in my office until some accommodation is reached where I can afford to purchase the vaccine," said Dan Levy, an Owings Mills, Md., pediatrician.

Even if their pediatricians are stocking the vaccine, some parents are waiting until they know whether they will be reimbursed.

"Some parents say, 'Yes, I'm going to get it, and I don't care about the insurance,' " said Edward Rothstein, a Sellersville, Pa., pediatrician. "But more often they say, 'Let me go home and check with my insurance company.' Girls who should be getting it aren't getting it because parents are justifiably concerned about cost."

Wait and See

Because of the uncertainties, some doctors are telling parents of young girls to wait a year until the insurance situation sorts itself out.

"My approach has been, 'I have this great new vaccine. I think everybody needs to get it. But because it's so new and so expensive and you have to have three doses, if you are not in that just-ready-to-have-sex age, let's wait a year and see if the insurance company picks it up,' " said Pamela Parker, a Silver Spring pediatrician.

Proponents of the vaccine say they are encouraged by the number of insurers that have committed to covering the vaccine, and they expect others to follow soon. Merck officials say the company is taking steps to mitigate the cost, including giving pediatricians more time to pay for their stocks and providing it free to poor women.

"We're doing whatever we can to make sure cost is not a barrier," Haupt said.