1. Short title This Act may be cited as the Life-Sustaining Prescription Drug Price Relief Act of 2019 . 2. Identification of excessively priced life-sustaining prescription drugs (a) In general The Secretary, not later than 1 year after the date of enactment of this Act, shall establish a process to conduct a review of all life-sustaining prescription drugs, not less frequently than once per calendar year, under which the Secretary determines under subsection (b) whether the price of each such drug is excessive. (b) Excessive price determinations (1) International reference price (A) In general The Secretary shall determine that any life-sustaining prescription drug for which the domestic average manufacturing price exceeds 110 percent of the average price charged for such drug in the 5 reference countries to have an excessive price. In assessing the extent to which the price is excessive, the Secretary shall consider the factors described in paragraph (2). (B) Reference Countries In this Act, the term reference countries means Canada, the United Kingdom, Germany, France, and Japan. (C) Requirement with respect to drugs for which certain reference country information is not available The Secretary shall make a determination under paragraph (1) for every life-sustaining prescription drug for which pricing information is available for at least 3 of the 5 reference countries. (2) Determinations based on other factors With respect to any life-sustaining prescription drug that is not determined to have an excessive price by operation of paragraph (1) (including any drug for which there is insufficient data to make such a determination under such paragraph), the Secretary shall determine that such drug has an excessive price if the price of the drug is higher than reasonable taking into account the following factors: (A) The size of the affected patient population. (B) The risk adjusted value of Federal Government subsidies and investments related to the drug. (C) The costs associated with development of the drug.