Personalised medicine has been prophesied to be the future of various medical facets, from epigenetics to treatment, serving Asia’s large population and promising technological capabilities. This review chapter includes peer-reviewed journal articles from PubMed, Scopus, Google Scholar, and Web of Science, as well as legitimate web-based sources, entailing two main sections. Firstly, it aims to analyse past historical trends and challenges in personalised medicine in various aspects: research, industry, governance, as well as ethical and legal considerations. Secondly, alternative futures for personalised medicine are depicted with those aspects in mind. We categorised three country tiers: tier 1 countries with a head start in genomics, such as China, tier 2 countries with newly-made genomic facilities, such as Thailand and Indonesia, and tier 3 countries, which include all other nations that have not initiated independent genomic facilities. These three tiers entail their unique opportunities, low-hanging fruits, and sociopolitical nuances, hence projecting different futures as consequences. This chapter also highlights the potential for disparities in which these futures merge in the context of global collaborations with or within Asia (e.g. GenomeAsia), key opportunities in a preferred future, and recommendations for a multisectoral approach in personalised medicine.