Background <p>Pharmacogenomic (PGx) testing improves treatment outcomes by tailoring therapy to a patient’s genetic profile. However, PGx implementation faces global challenges, including costs, reimbursement, and regulations. Initial PGx guidelines exist in the United Arab Emirates (UAE), but insurers’ perspectives remain understudied. This study explores insurers’ views on policies and strategies to expand PGx adoption and overcome implementation barriers.</p> Methods <p>This qualitative study used a semi-structured interview design to explore the perspectives of twelve executive and middle management insurance representatives selected through purposive convenience and snowball sampling. Thematic analysis was conducted inductively, supported by comparative analysis, the Institutional Theory, the TAM, and SWOT analysis to interpret the findings.</p> Results <p>Analysis revealed variable awareness of PGx, highlighting both perceived benefits and significant barriers. Key findings included economic constraints, limited physician and public awareness, and policy challenges related to cost-effectiveness and infrastructure. Ethical and privacy concerns were minimal but were noted, with potential implications for insurance premiums. Participants stressed the need for collaborative efforts to align PGx with UAE healthcare goals and highlighted the role of advanced health information systems in facilitating integration. Differences emerged between executive and middle-level management: the former emphasised strategic policies and long-term returns on investment, while the latter focused on practical operational barriers.</p> Conclusions <p>Advancing PGx in the UAE requires local cost-effectiveness studies, clear government-led coverage guidelines, and collaborative action among insurers, providers, regulators, and academia. These findings may inform health systems with similar public–private insurance arrangements, where phased adoption strategies and education initiatives are key to sustainable implementation.</p>