Institutional Implementation of Pharmacogenomics: Health Systems Policies, Barriers, and Best Practice Models

Pharmacogenomics (PGx) offers a clinically actionable route to precision prescribing: by tailoring drug selection and dosing to an individual’s genetic profile, it has the potential to reduce adverse drug reactions, improve therapeutic outcomes, and lower the burden on health systems. Despite decades of foundational research and the development of internationally recognised clinical guidelines from bodies including CPIC and DPWG, PGx remains substantially underimplemented in routine care. The gap between evidence and practice is no longer primarily scientific. Health systems across high-, middle-, and low-income settings continue to face a common set of challenges: fragmented laboratory infrastructure, limited clinical decision support integration, variable clinician training, absent reimbursement frameworks, and a lack of clear governance models for PGx delivery at scale. At the same time, a growing number of early-adopter institutions spanning academic medical centres, national paediatric networks, and integrated primary care systems have demonstrated that implementation is achievable. These programmes offer a critical, underutilised evidence base from which transferable lessons can be drawn.This Research Topic aims to consolidate and critically examine the institutional evidence base for pharmacogenomics implementation. It seeks to define what works, for whom, and under what conditions, generating a practical, evidence-driven resource that health systems, policymakers, and clinical leaders can use to accelerate responsible and equitable PGx adoption.We welcome original research, systematic reviews, perspective articles, and case studies addressing:- Institutional and national PGx programmes, including pre-emptive, reactive, and disease-specific implementation models across primary, secondary, and tertiary care settings- Health policy, funding, reimbursement, and regulatory frameworks that shape the pace and breadth of PGx adoption- Clinical decision support and electronic health record integration as enablers of scalable, workflow-embedded PGx delivery- Workforce readiness, including clinician knowledge, attitudes, and competency frameworks required for sustainable implementation- Equity and access considerations, including programme performance across paediatric, geriatric, and underserved populations, and the impact of genomic database diversity on clinical utility- Health economic evidence, including cost-effectiveness analyses, budget impact models, and return-on-investment data from operational programmes- Comparative and cross-system analyses that identify transferable best practice models and highlight the conditions under which they succeed- Submissions that move beyond feasibility to address scalability, sustainability, and system-level impact are particularly encouraged.Articles should fit into the Journal’s mission & scope. Further information on the Journal’s scope can be accessed following the link https://www.frontiersin.org/journals/pharmacology/about Topic editors: Rachel Conyers, Amanda Massmann, Farah Kidwai-Khan Source: https://www.frontiersin.org/research-topics/82993/institutional-implementation-of-pharmacogenomics-health-systems-policies-barriers-and-best-practice-models