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Benefit Program Client Services (BPCS) is used to facilitate the intake process of new Ontario Drug Benefit (ODB) recipients as well as the validation and payment of invoices. BPCS manages ODB program recipient eligibility and administration of deductible and co-payment-based programs. At a high level, BPCS primarily supports the functionalities below:

  • Registration of new Trillium Drug Program (TDP) or Seniors Co-payment Program (SCP)
  • Adjudication of pharmacy prescription receipts
  • Administration and management of the recipients enrolled in ODB Programs
  • Registration and maintenance of the ODBP recipient’s information such as: personal data, address, program enrolment and eligibility dates

The purpose of the BPCS Implementation Guide is to provide the technical guidelines that vendors must adhere to in order to interact with the Health Network System’s BPCS FHIR API. Using the API, authorized client applications can query, create and update relevant records in support of BPCS business functions.

This FHIR API provides the BPCS functionalities within the existing Health Network System’s back-end ecosystem. Consequently, its functionality is limited by the capabilities of the current back-end. Some features are exposed as FHIR operations and named queries, while others impose strict limitations on standard RESTful interactions due to constraints on search types and data manipulation. Additionally, there are instances where multiple resources must be passed as input to a business function. Despite these challenges, FHIR design principles have been followed as closely as possible, and pure REST interactions are utilized whenever they align with the existing system's functionality.

Functionality of the BPCS API is divided into six main business areas. Each area and their associated interactions, queries, and operations available are documented in below API sections:

Example API payloads are available within each API section. However, we have provided additional example scenarios for the Claims interactions with BPCS to assist vendors with the API implementation process: