From the article:

While drug companies profit from the sales of unproven drugs, everyone else — patients, insurers, and the government — pays a heavy price. In just four years, from 2018 through 2021, the taxpayer-funded health insurance programs Medicare and Medicaid shelled out $18 billion for drugs approved on the condition that their manufacturers produce confirmatory trials that had yet to be delivered.

I’m guessing their citation only includes Medicare and Medicaid because those have publicly-available data for the study to review, but I have to assume that private insurers pay a ton as well. I can see your point that insurance denials result in angry sick people, but there’s not really a lot of nuance in “that medication has never been shown to be safe and effective for your (or any) condition.”

I dunno. Everyone sucks here.