Pharmacogenomics (PGx) is transforming precision medicine by elucidating how genetic variability influences drug response, efficacy, and toxicity. Over the past decade, numerous pharmacogenomic implementation consortia, including the Clinical Pharmacogenetics Implementation Consortium (CPIC) and the Dutch Pharmacogenetics Working Group (DPWG), have developed evidence-based guidelines for genotype-guided therapy. However, translation into clinical practice remains incomplete. Regulatory discrepancies between CPIC/DPWG guidelines and drug labeling, limited health system infrastructure, and disparities in global adoption continue to hinder clinical integration. This review synthesizes evidence from recent literature, including regulatory analyses, global implementation efforts, cost-effectiveness studies, and real-world clinical outcomes, to highlight progress and remaining challenges in bridging pharmacogenomic discoveries and clinical application. The review concludes with future directions, emphasizing harmonization of guidelines, policy alignment, data integration into electronic health records (EHRs), and equitable access to pharmacogenomic testing across healthcare systems worldwide.