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$0 copay (after your deductible, if applicable) and no prescription required for Medical Mutual members for: _____Prilosec OTC® or OTC/store-brand omeprazole _____Dosage quantity of up to 56 tablets for up prilosec to a 30-day period* Member name___________________________________________________________ Member ID number_______________________________________________________ Follow your provider’s instructions or take according to the manufacturer’s label for 14 days to treat frequent heartburn .
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dd EnterpriseRx Code 70050 (Medco-OTC-Coupon) to patient’s insurance nter the Medical Mutual member ID information in the Policy/ Cardholder field, and then enter prilosec MMODRUG in the Group field .
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