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David F Kisor,1 Natasha J Petry,2,3 David R Bright4 1Manchester University, Department of Pharmaceutical Sciences and Pharmacogenomics, Fort Wayne, IN, USA; 2North Dakota State University, College of Health Professions, Department of Pharmacy Practice, Fargo, ND, USA; 3Sanford Imagenetics, Sioux Falls, ND, USA; 4Ferris State University, Department of Pharmaceutical Sciences, Big Rapids, MI, USACorrespondence: David F KisorManchester University, Department of Pharmaceutical Sciences and Pharmacogenomics, 10627 Diebold Road, Fort Wayne, IN, 46845, USATel +1 260-470-2747Fax +1 260-470-4440Email dfkisor@manchester.eduAbstract: Pharmacogenomics (PGx) is expanding across health-care practice settings, including the community pharmacy. In the United States, models of implementation of PGx in the community pharmacy have described independent services and those layered on to medication therapy management. The drug–gene pair of clopidogrel-CYP2C19 has been a focus of implementation of PGx in community pharmacy and serves as an example of the evolution of the application of drug–gene interaction information to help optimize drug therapy. Expanded information related to this drug–gene pair has been provided by the US Food and Drug Administration and clinical PGx guidelines have and continue to be updated to support clinical decision-making. Most recently direct-to-consumer (DTC) PGx has resulted in patient generated sample collection and submission to a genetic testing-related company for analysis, with reporting of genotype and related phenotype information directly to the patient without a health-care professional guiding or even being involved in the process. The DTC testing approach needs to be considered in the development or modification of PGx service models in the community pharmacy setting. The example of clopidogrel-CYP2C19 is discussed and current models of PGx implementation in the community pharmacy in the United States are presented. New approaches to PGx services are offered as implementation continues to evolve and may now include DTC information.Keywords: pharmacogenomics, pharmacogenetics, clopidogrel, community pharmacy, implementation

Benjamin Q Duong,1 Meghan J Arwood,2 J Kevin Hicks,3 Amber L Beitelshees,4 Francesco Franchi,5 John T Houder,2 Nita A Limdi,6 Kelsey J Cook,7,8 Aniwaa Owusu Obeng,9 Natasha Petry,10 Sony Tuteja,11 Amanda R Elsey,2 Larisa H Cavallari,2 Kristin Wiisanen2 on behalf of the IGNITE Network1Department of Precision Medicine, Nemours/Alfred I. DuPont Hospital for Children, Wilmington, DE, USA; 2Department of Pharmacotherapy and Translational Research and Center for Pharmacogenomics & Precision Medicine, University of Florida College of Pharmacy, Gainesville, FL, USA; 3Department of Individualized Cancer Management, Moffitt Cancer Center, Tampa, FL, USA; 4Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; 5Department of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA; 6University of Alabama School at Birmingham, Birmingham, AL, USA; 7Department of Pharmacotherapy and Translational Research, University of Florida College of Pharmacy, Jacksonville, FL, USA; 8Department of Precision Medicine, Nemours Children’s Specialty Care, Jacksonville, FL, USA; 9The Charles Bronfman Institute for Personalized Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA; 10Department of Pharmacy Practice, North Dakota State University College of Health Professions, Fargo, ND, USA; 11Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USACorrespondence: Kristin WiisanenDepartment of Pharmacotherapy and Translational Research and Center for Pharmacogenomics & Precision Medicine, University of Florida College of Pharmacy, P.O. Box 100486, Gainesville, FL 32610-0486, USATel +1 352-273-5114Email kwiisanen@cop.ufl.eduIntroduction: Clinical adoption of genomic medicine has lagged behind the pace of scientific discovery. Practice-based resources can help overcome implementation challenges.Methods: In 2015, the IGNITE (Implementing GeNomics In pracTicE) Network created an online genomic medicine implementation resource toolbox that was expanded in 2017 to incorporate the ability for users to create targeted implementation guides. This expansion was led by a multidisciplinary team that developed an evidence-based, structured framework for the guides, oversaw the technical process/build, and pilot tested the first guide, CYP2C19-Clopidogrel Testing Implementation.Results: Sixty-five resources were collected from 12 institutions and categorized according to a seven-step implementation framework for the pilot CYP2C19-Clopidogrel Testing Implementation Guide. Five months after its launch, 96 CYP2C19-Clopidogrel Testing Implementation Guides had been created. Eighty percent of the resources most frequently selected by users were created by IGNITE to fill an identified resource gap. Resources most often included in guides were from the test reimbursement (22%), Implementation support gathering (22%), EHR integration (17%), and genetic testing workflow steps (17%).Conclusion: Lessons learned from this implementation guide development process provide insight for prioritizing development of future resources and support the value of collaborative efforts to create resources for genomic medicine implementation.Keywords: pharmacogenomics, CYP2C19, clopidogrel, implementation, precision medicine, personalized medicine, clinical pharmacogenomics, CYP2D6