Poor reimbursement and high cost are reasons why:

Teri Perryman, a doctor in Kerrville, Tex., is not only avoiding Gardasil and RotaTeq, but also not offering the new meningitis vaccine, flu shots or new expensive combination products like one that combines the chickenpox vaccine with the measles-mumps-rubella vaccine, according to her husband, Kevin Perryman, who helps manage the practice.

Other doctors are asking patients to pay upfront or, in a new twist, are sending them to the drugstore. Typically, physicians have not written prescriptions for vaccines, as they do for drugs, but instead buy and store them, recouping their money when they give the vaccines to patients.