; (iii) how States and managed care entities determine payment for specialty drugs; (iv) the settings in which specialty drugs are dispensed to individuals receiving benefits under this title (such as retail community pharmacies or specialty pharmacies); (v) the extent to which speciality drugs (as defined by the respective States) are captured in the national average drug acquisition cost survey (or through another process); (vi) examples of specialty drug dispensing fees to support the services associated with dispensing such specialty drugs; and (vii) recommendations as to whether specialty pharmacies should be included in the survey of retail prices to ensure national average drug acquisition costs capture drugs sold at specialty pharmacies, and how such specialty pharmacies should be defined. (I) Enforcement At the discretion of the Secretary, the Secretary may enforce non-compliance with this paragraph by a pharmacy through the establishment of penalties or the suspension of payments under this title, in full or in part, until compliance with this paragraph has been completed. ; and (C) in paragraph (2)— (i) in subparagraph (A), by inserting (including payment rates under Medicaid managed care plans) after under this title ; and (ii) in subparagraph (B), by inserting , and the basis for such dispensing fees before the semicolon at the end. (2) Effective date The amendments made by this subsection take effect on the first day of the first quarter that begins on or after the date that is 18 months after the date of enactment of this Act.