Pharmacogenomic testing can identify clinically relevant gene–drug variation, but its value in pharmacy practice depends on whether results are converted into interpretable and timely prescribing decisions. Implementation therefore extends beyond laboratory testing to result delivery, decision support, professional interpretation, workflow integration, and continuity across care settings. To map how pharmacogenomic testing was integrated into prescribing workflows across pharmacy practice settings from 2017 to 2026, with particular attention to clinical integration pathways, decision-support modalities, pharmacist roles, implementation conditions, and evidence gaps. A scoping-review approach was used to map heterogeneous implementation evidence. Eligible literature addressed clinically actionable pharmacogenomics, clinical integration, decision support, pharmacist participation, prescribing response, or implementation within identifiable healthcare settings. Evidence was charted by setting, testing model, gene–drug scope, workflow location, interpretation actor, pharmacist function, prescribing-action endpoint, implementation conditions, and evidential boundaries. The mapped literature encompassed academic health systems, primary care, community pharmacy, rural systems, specialty services, inpatient care, behavioral health, and multinational implementation programs. Testing availability did not consistently correspond to prescribing action. Decision support varied in timing, specificity, workflow position, and clinical contextualization, while pharmacists occupied roles extending from test initiation to interpretation and prescriber consultation. Implementation barriers and enabling conditions were setting-dependent. Pharmacogenomic implementation is better understood as a series of distinguishable clinical states rather than as test availability alone. The review maps where translation toward prescribing action occurs, where it fails, and where evidence remains limited without assuming that implementation necessarily produces clinical benefit.
Impact Statements
