Some of the most productive areas of US government biomedical research have not come from NIH but from DoD. Most people do not realize that virtually all modern trauma medicine was invented by US military research as a very active ongoing program. If you get in a bad automobile accident, most things that happen will be the product of US military research. But interestingly, these programs have very sparse research budgets, literally just single millions of dollars in many cases. But that is trauma medicine, not drug development.
Drug trials in particular are extremely expensive. People like to pretend these don’t exist. A few million in research costs doesn’t write off billions of dollars in development costs. There is no mathematical way to argue otherwise.