This article is about someone getting cutting edge care beyond medical literature from the one of the leading experts in the world. I've got to imagine most health funds would simply not be able to cover that type of care for an individual?
The gastroenterologist is not the expensive part, either, the expensive part was the manufacturing process for the drug. It would be super cool to invest the billions of profit for this insurance company into developing more efficient ways to produce this category of drug. Alas,
Instead we are investing in finding the most underhanded ways possible to deny medical care for each patient, all the while pretending we are not making medical decisions for them.
Also I would agree the insurer is absolutely making medical decisions with its own definition of medical necessity. But the Doctor is also making financial decisions when he recommends a drug that pays him significant consulting fees every year. There's warped incentives all over.
This is the paradox of US healthcare: it's probably the most advanced in the world if you/your insurer can foot the bill, but that's an enormous if.
The situation at the moment is that routine, basic medicine is being denied, often algorithmically, along with "pharmabro" types buying up basic medications for the sole purpose of increasing its price. That's starkly different from the development of novel medications demanding high prices to reward R&D efforts.