Pharmaceutical manufacturers continue to face significant challenges understanding what affiliated fees actually buy within pharmacy benefit manager contracting structures.
A Federal Trade Commission settlement with Express Scripts, announced on February 4, 2026, required major business practice changes, including transparency reforms and reshoring the Ascent group purchasing organisation.
Despite the settlement moving one PBM aggregator onshore, manufacturers still lack contract-level clarity on the compensation flowing through affiliated entities.
Rebate aggregators and affiliated contracting entities can sit between manufacturers and PBMs while receiving compensation that is extremely difficult to evaluate at the contract level.
Industry consultants argue that if a fee is charged for a bona fide service, that service should be identified, documented, and priced at fair market value.
If a fee is not tied to a real service, the manufacturer is not simply negotiating rebates but instead funding another opaque layer in the pharmacy benefit supply chain.
Contract language ahead of Consolidated Appropriations Act 2026 changes should force entity identification, fee schedules, payment recipients, and consistent economics across similarly situated manufacturers.
Agreement language should also require certifications of performed services at fair market value and bar WAC, rebate, or utilisation-based percentage fees unless those fees are clearly disclosed.
Audit rights to validate calculations and payment recipients have become a central demand among manufacturers seeking greater accountability within these contracting arrangements.
One pharmacist and industry consultant noted that “data access” has appeared in manufacturer agreements as a fixed flat charge even when evidence of a corresponding data service is entirely absent.
As that consultant put it directly, “That is not a theoretical concern; it is a contract problem,” underlining the practical scale of opacity manufacturers regularly encounter.
Timing has also emerged as a critical factor, with calls to repatriate offshore aggregator entities now risking missing business practice changes that have already taken effect in early 2026.
The broader concern is that without enforceable contract-level transparency, manufacturers will continue to fund intermediary layers whose services and compensation remain inadequately documented and verified.