What is this alert?
Pearl’s Medication Adherence Alert identifies patients with Heart Failure or Atrial Fibrillation who may not be taking their medications as prescribed.
Heart Failure (HFrEF): Patients missing fills for one or more of the 4 drug classes recommended under Guideline-Directed Medical Therapy (GDMT):
Beta-blockers: Carvedilol (Coreg), Metoprolol succinate [ER] (Toprol XL), Bisoprolol (Zebeta)
ACE inhibitors / ARBs / ARNI: Lisinopril (Zestril/Prinivil), Enalapril (Vasotec), Ramipril (Altace); Losartan (Cozaar), Valsartan (Diovan), Candesartan (Atacand); Sacubitril/Valsartan (Entresto)
MRAs: Spironolactone (Aldactone), Eplerenone (Inspra)
SGLT2 inhibitors: Dapagliflozin (Farxiga), Empagliflozin (Jardiance)
Atrial Fibrillation: Patients with a high CHA₂DS₂-VASc score (≥2 for males, ≥3 for females) who do not have evidence of anticoagulant fills:
Warfarin (Coumadin)
DOACs: Apixaban (Eliquis), Rivaroxaban (Xarelto), Dabigatran (Pradaxa), Edoxaban (Savaysa)
The alert is based on Medicare Part D pharmacy fill data, which updates monthly, and surfaces in the “Do Now” section of the Prioritized Patient List.
Why does it matter?
Medication adherence in these patients is directly tied to reducing:
Inpatient admissions
Emergency department visits
Stroke and other complications
Total medical costs
Even short lapses in therapy can increase risk. These alerts are designed to help practices catch non-compliance early and close gaps quickly.
What you should do
When you see this alert, we recommend:
Schedule a follow-up within 14 days to review medications.
Review the patient’s medical history to confirm all meds are appropriate and necessary.
Discuss with the patient — ask about barriers like cost, side effects, or pharmacy access, and provide education.
Document contraindications or specialist management when relevant.
How alerts are completed in Pearl:
✅ Scheduled a new appointment
✅ Patient already had recent appointment / med rec
✅ Clinical team spoke with patient and conducted assessment/care plan support
Best practices for using these alerts
Incorporate alerts into existing workflows (e.g., AWVs, CCM calls, TCM visits, routine follow-up).
Check fill history in patient view before outreach to spot recent fills.
Keep charts up to date with contraindications or cardiology notes.
Use motivational interviewing and open-ended questions (not just yes/no) to uncover barriers.
Common questions
What data is this based on?
The alert is powered by Medicare Part D fill data, the same source CMS and payors use to track adherence.
Why might the alert look “wrong”?
Some fills may not appear if patients use:
Cash payments
Discount or assistance programs
Free samples
Supplemental drug plans outside Part D
That’s why the alert should be used as a prompt to confirm adherence, not an absolute directive.
What if the cardiologist is managing the patient’s meds?
That’s common. The PCP team can still use the alert as a safety net to confirm adherence and ensure visibility across the care plan.
What if the patient says they’re adherent but the alert fires?
Check the fill history in patient view. If fills are missing from Part D, ask how the patient is actually receiving their medications.
What if a recent med rec was done?
You can complete the alert by selecting the option: “Patient already had recent appointment or med rec.”
Do these alerts affect my performance numbers?
Yes. They appear in the Do Now panel and count toward Do Now completion. They do not currently impact quality measure denominators directly but support performance by reducing admissions and complications.
How often do alerts refresh?
Medication adherence alerts refresh monthly with the latest Part D data.