Most parents want to protect their children at any cost. But $360 for one vaccine?

A potential Illinois law requiring HPV vaccinations for all girls could put doctors and their patients in a bind. Some smaller and solo practices can't afford to stock the vaccine, meaning patients either have to wait or foot the bill themselves in the hope their insurance company will reimburse them.

Diane Egan, of Deerfield, said her 14-year-old daughter will be getting the HPV vaccine at her next physical. Egan doesn't know if her insurance covers the vaccine, but "it doesn't matter because I want my daughter to be as well protected as she can be," she said.

The human papillomavirus vaccine Gardasil, manufactured by Merck, protects against cervical cancer. The vaccine costs $360 for the three required doses.

For medical practices, however, sales tax and federal excise tax can increase the cost to almost $140 a dose. And then there is the cost of refrigerated storage, insurance and the time it takes to administer the vaccine.

Although each vaccine has these related costs, Gardasil is one of the more expensive vaccines in recent years.

"It costs significantly more than any other vaccine that I know of that we use," said Dr. David Oppenheim, a pediatrician at Premier Pediatrics in Lincolnshire. "Cost will always be an issue due to the expense of this vaccine."

On top of the upfront costs, pediatricians are not always sure if they will be reimbursed by insurance companies. Oppenheim said late last fall that one insurance provider did not reimburse for Gardasil because it said the shot was still experimental.

"This was long after the FDA approved it and after it was on the ACIP recommendations," he said. The Advisory Committee on Immunization Practices is a federal committee that recommends the administration of vaccines.

Physicians don't know until after they submit a claim whether an insurance company will cover Gardasil. And even those insurance companies that do cover the vaccine often don't reimburse adequately, doctors say.

The American Academy of Pediatrics says insurers should reimburse pediatricians at least 17 percent above the wholesale cost of Gardasil, which varies for each practice based on its contract with the vaccine provider. But many times insurance companies only pay for the wholesale cost of the vaccine or slightly more.

While most pediatricians support protecting girls against cancer, the cost has some concerned about mandating vaccination. If approved, the Illinois Senate bill would require that all 11- and 12-year-old girls in the state be vaccinated or sign an opt-out form after being educated about the link between HPV and cervical cancer.

Sen. Debbie Halvorson, D-Crete, who is sponsoring the bill, said the committee is looking at what it will cost the state to vaccinate underinsured girls. She said pediatricians who can't afford to carry Gardasil should discuss with their patients alternate options for how they can get the vaccine.

"We don't want to put undue pressure on anybody to carry it," she said. "Nobody will be mandating they stock it."