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TRENTON, N.J. — Girls jumping rope chant "one less, one less," in TV commercials for the new cervical cancer vaccine Gardasil, vowing they will be one less cancer patient.

But in the real world, Gardasil is getting used less than doctors would like.

Pediatricians and gynecologists from Arizona to New York are refusing to stock Gardasil because of its $360 price for the three doses required and "totally inadequate" reimbursement from most insurers.

Pediatricians, in particular, are rebelling, fed up after years of declining insurance reimbursement for vaccines, an explosion of new vaccines and fast-escalating vaccine prices.

Many practices must tie up $50,000 or more in vaccine inventory, run multiple refrigerators, insure the vaccines and spend lots of time on inventory management.

They also must absorb the cost of broken or wasted vials, and say that's not possible with most insurers reimbursing at just $2 to $15 over the $120 per dose charged by Gardasil's developer, Merck & Co. of Whitehouse Station, N.J.

"Doctors are drawing a line in the sand on this. They're either not giving it or requiring a surcharge," said Dr. Daniel Schwartz of Broadway Pediatrics Associates in Westport, N.J., which charges patients a $25 surcharge per shot.

Pediatricians and gynecologists at solo and large group private practices contacted by The Associated Press said they would, at best, break even if they stocked the vaccine.

Most will give patients a prescription to get filled and bring back, but that could cost patients far more.

"I don't know where to turn," said Julie Falco, a Marlboro, N.Y., elementary school teacher trying to get her 13- and 15-year-old daughters vaccinated.

Her pediatrician, Dr. Herschel Lessin told her his 20-doctor Children's Medical Group in Poughkeepsie, N.Y., can't afford to stock Gardasil.

Lessin said insurers paying their executives millions won't give him $25 to cover his costs but will spend tens of thousands if a patient develops cervical cancer.

His practice will provide prescriptions but warned Falco her insurer might not reimburse her, and pharmacies might mark each dose up to $200. Falco then tried her gynecologist, who sent her back to the pediatrician.

"I still don't have the shot, and now I have to decide whether I want to make a $1,200 investment to get them vaccinated," she said. "I really don't want to deny them what I think is right."