BOX 1.

List and role of main stakeholders involved in the pharmacogenomics (PGx) implementation process in a hospital setting

Stakeholder	Role
Regulatory bodies	Authorize or require specific PGx tests.
	Provide guidelines and/or drug labeling.
	Monitor implementation.
	Communicate with hospital leadership and payers.
Hospital leadership	Secure funds and infrastructure.
	Lead the process and identify early adopters of change.
	Ensure compliance with ethical, legal and social issues.
	Monitor and evaluate the program’s impact.
	Contribute to and lead new policies.
	Communicate with regulatory bodies, payers, and pharmacy and therapeutics committee.
Pharmacy & Therapeutics Committee	Evaluate the available evidence in consultation with PGx consortia and networks.
	Review the most relevant drugs.
	Narrow down to the most actionable drug-gene pairs with related variant alleles.
	Monitor and evaluate the program for improvement.
	Communicate with hospital leadership, laboratory, information technology and healthcare providers.
Laboratory	Perform genotyping.
	Apply reactive point of care or preemptive testing.
	Choose candidate vs. panel testing.
	Communicate with pharmacy and therapeutics committee, information technology and healthcare providers.
Information Technology	Report and integrate results into electronic health records.
	Design clinical decision support systems.
	Communicate with pharmacy and therapeutics committee, laboratory, and healthcare providers.
Healthcare provider	Order the test.
	Understand and interpret the test results.
	Make therapeutic decisions.
	Educate the community.
	Communicate with patients, pharmacy and therapeutics committee, laboratory, and information technology.
Patient	Provide feedback on drug outcome
	Communicate with payers and healthcare providers.
Payer	Reimburse (or not) the test partially or fully
	Communicate with regulatory bodies, hospital leadership and patients.