A physician writes to the WSJ:

This vaccine costs pediatricians $120 per dose. When vaccines cost $10 and payers paid $12; that was manageable. Now that the cost is $120 per dose, payers still think it reasonable to pay $122 per dose. They argue that we make a profit as long as they pay us at least our cost, although many pay less. Anyone who runs a business realizes that this is pure sophistry. Due to our enormous overhead costs, we must receive 17% to 28% above the wholesale cost simply to break even. It would cost $2 million to provide this vaccine in our large practice. We would have to borrow that much capital for a “return” of perhaps $2.04 million. We would lose less by keeping that money under a mattress. As a small business, we can’t justify that expense.