Why charges for refills outside visits?

Fair question.  First let me explain how the number of refills is chosen, then turn to "why a charge?" 

If I'm doing my job right, when the pharmacy won't give you another refill because no more are authorized, there is a reason.  When choosing how many refills to authorize while I'm writing the prescription in the office, the number is based on factors like:

Some medications have "standards of care" which dictate how long we can go without lab testing.  Lithium is the primary example of this, where several wise men (I'm sure they were men) decided that these tests should be done every six months.  After doing these tests for years, I think young healthy folks can afford to go a little longer in between, whereas older folks with some reason to worry about their kidneys, for example, should be tested much more frequently than that.  So I might vary somewhat from this "standard", but if I get too far away from it, I'll be liable for legal trouble if there's a bad outcome later.  So I try to balance your need not to get stuck with a needle, or pay lab fees, too often;  versus my need to know what's going on or at least keep from too much legal liability. 

Thus I use your refill amounts as a way to keep some control over things where necessary.  If a patient demonstrates that she is capable of taking responsibility for details like getting a thyroid and kidney and lithium test every six months while being seen for something else by her primary care doctor, I might give her a year's supply at a time. 

You're welcome to ask me, and help me decide, how many refills are to be authorized. 

Why Charge?

When you're in my office, authorizing refills is really easy:  your chart is in front of me, and you're in front of me in case there's something I need to check with you, like exactly how many pills you're taking in the morning.  Authorizing refills when you're not right in front of me, nor your chart, can take a lot more time.  If you need to call me for a refill, something is happening outside the usual boundaries of the "reasons" noted above.  You might be heading for extended travel; or you may have changed how you're taking the medication; or you may have had to reschedule an appointment for a later time.  Under those circumstances I think its fair to ask you to pay for my time to take care of the problem. 

If you have insurance to help pay for your care, you can use up one of your sessions to come in to deal with a medication refill issue (as explained above, that may well have been my plan in the first place). Alternatively, you can use the brief email route and pay the minimum charge, because you'll give me (if you're smart) the information in your email that makes it clear:  you're okay out there, our "game plan" is working fine, and you don't need to come in.   If I'm satisfied with that, I'll just post it in your chart and fax in the refills -- if I know you well enough to know you'll contact me if something changes and you need help.