Since the ECJ case in Elida Gibbs, the VAT implications of most discounts are clear: the taxable amount is reduced by the discount that is provided. However, the outcome is much less clear when businesses provide discounts to parties that are not operating in the same distribution chain. Such complex discount schemes occur, in particular, in markets with pricing pressure like the pharmaceutical sector. In that specific sector, insurers and governments are coming up with pricing arrangements in order to control the rising drug prices. Along with these arrangements, additional cash flows often are created and third parties become involved. In this article, the author discusses the VAT implications of such pricing arrangements and gives real-life examples from Germany and the Netherlands. He concludes by outlining the various arguments that can be found in the ECJ case law in order to unblock the bottlenecks.