There is a moment that happens thousands of times a day across American healthcare, and almost no one talks about it. A doctor prescribes a medication. The patient leaves the office with some version of hope. And somewhere in the background, an enrollment form gets filled out, partially filled out, or left blank. That quiet moment is where patient access starts to break down.
That quiet moment is the subject of the latest Access Forum Executive Insights conversation, embedded above. zPaper VP of Product Tom Malone sits down with Laura Viaches, who spent more than two decades at Eli Lilly leading a global patient services organization before founding Endeavor Pharma Solutions. Together, they unpack a problem the industry has been fighting for decades: the PSP enrollment gap.
Watch the full conversation here. Below are the key takeaways.
Despite years of investment in fax replacement, portals, and sophisticated hub systems, enrollment forms still arrive incomplete, and some never arrive at all.
What the PSP enrollment gap actually is
The enrollment gap is the distance between what a hub needs to act on a patient and what it actually receives. Viaches frames it bluntly: the biggest problem is getting complete enrollment forms, or worse, never even getting them at all. Across the industry, enrollment numbers are far below the total number of patients on a given product, meaning a real share of patients never reach the manufacturer's hub in the first place.
Of the forms that do arrive, almost any field can be blank. Missing signatures are the most common, followed by incomplete insurance information and a missing or unmatched prescription. Some of these are minor. Others are critical-path errors that halt everything until the information is recovered.
Why digitizing the form did not close the gap
Manufacturers have poured money into digital enrollment, so it is fair to ask why the problem persists. According to Viaches, the answer is largely a lack of standardization. Pharmaceutical commercialization has benefited enormously from standards like NCPDP formats and NDC 11 codes, but no equivalent exists for patient support enrollment. Beyond required consents and authorizations, manufacturers have wide latitude in how their forms look, so a single staff member in a busy office may face a different layout for every product they touch.
Moving that confusion onto a screen does not fix it. The same questions that tripped people up on paper still trip them up in a portal. Viaches also points to portal fatigue, a problem she hears about constantly in physician offices, where staff juggle eight different logins and simply give up. When a digital field throws an error, office staff often do not know who to call, so they wait for a field reimbursement manager or forget to ask at all.
What incomplete forms cost patients and hubs
The downstream cost is where this stops being an operations headache and starts being a patient access problem. The case that worries Viaches most is the missing patient signature. Without it, and without the authorization it carries, the hub cannot legally contact the patient under rules like the Telephone Consumer Protection Act. The patient was told someone would reach out. No one can. The form is sent back to the physician's office for recovery, adding a step to an already overloaded workflow and sharply increasing the odds that the enrollment form will never be completed.
Even when outreach is possible, patients are wary of unexpected calls and texts about their medication, so loss to follow-up climbs. Meanwhile, the patient may be paying a far higher out-of-pocket cost than necessary because no one captured the information needed to apply a manufacturer copay card. Far fewer patients enroll in copay support than are eligible for it. The same gap blocks benefits investigations, nurse injection training, and the ongoing support that keeps patients on therapy. A blank field quietly becomes a patient who hesitates, delays, or walks away.
What "complete from day one" actually looks like
Viaches is clear about where the industry needs to go. First, standardization wherever possible around enrollment, consent, authorization language, and terms. Second, integration in two directions. Enrollment has to fit within the physician's natural workflow, so capturing consents and advancing the form is the obvious next step after a prescription, not a separate chore. And it has to connect to EHR systems and e-prescribing, so the script, the record, and the enrollment stay accurate and complete together.
Above all, it has to be genuinely easier to use than the paper form it replaces. That is a high bar, since people have been filling in forms with a pen since kindergarten, and some enrollment packets run ten pages once every consent is counted. But Viaches believes it is achievable, and manufacturers that treat their patient support programs as an investment rather than a cost center are closing the gap fastest.
The full conversation goes deeper on error rates at launch, the e-prescribing shift, and the recovery process when a form comes in broken. Watch it at the top of this page, and when you are ready to see what complete-from-day-one enrollment capture looks like in practice, explore how zPaper FastPass and DocJS keep enrollment data clean from the first submission.
Frequently asked questions (FAQs)
1. What is the PSP enrollment gap?
It is the gap between the complete enrollment information a patient support program hub needs and what it actually receives. It includes forms that arrive with missing fields, such as a patient signature or insurance details, and forms that never reach the hub at all.
2. What is the most common error on PSP enrollment forms?
Missing patient signatures are the most frequent issue. Without a signature and the authorization it carries, the hub often cannot legally contact the patient, which stalls the entire enrollment.
3. Why hasn't digital enrollment solved the problem?
Because the core issue is a lack of standardization, not the medium. The same confusing questions that caused errors on paper persist in portals, and portal fatigue adds friction when staff manage many separate logins and forms.
4. How do incomplete enrollment forms affect patients?
They cause delays in starting therapy, higher out-of-pocket costs when copay support is not applied, and loss to follow-up when hubs cannot reach patients. In some programs, the patient cannot access the product until the missing information is recovered.
