Comment: Re:Generally, when prescription drugs.... (Score 1) 392
To fill your prescription at one of the participating Network retail pharmacies,
... you pay only the appropriate coinsurance or copayment amount.
coinsurance = % appropriate = it varies based on the drug category
which really means the more expensive the drug, the higher percentage of the higher price you will need to pay
To file a claim for reimbursement from an out-of-network pharmacy: When your claim is processed, you will be reimbursed up to 55% of the drug's Average Wholesale Price (AWP) for covered medicines and supplies purchased at an out-of-network pharmacy.
Where AWP is code for, "determined however the insurance company feels like", much like Reasonable and Customary is.