Key learnings from building: A precision cancer medicine implementation initiative for Norway

European countries with publicly funded health care struggle with implementation of precision cancer medicine (PCM). We set out three aims in 2019: i) To establish access to advanced molecular diagnostics for stratification of patients to trials; ii) To increase the volume of trials with a PCM approach to gain experience; and iii) In parallel work for implementation of PCM into standard of care. Work proceeded along four lines: i) Sign-up to a nation-wide, bottom-up initiative with a few common priorities; ii) Aligning with top-down approaches from the Ministry and regional health care systems; iii) Exploring the possibility of a public-private partnership and iv) Coordinating with other PCM initiatives internationally. Over the past two years we have built the InPreD-Norway national infrastructure for precision cancer diagnostics allowing stratification into PCM trials with a national molecular tumor board (publicly reimbursed, screened >300 in the first year), the IMPRESS-Norway national researcher-initiated PCM intervention trial (https://impress-norway.no), which opened for inclusion Q2 2021 and runs at all hospitals that treat cancer patients (22 sites, 17 hospital trusts; ), the INSIGHT/INCLUDE projects for research on control cohorts, use of real world evidence (RWE), health economics and reimbursement models, ethics, legal aspects and governance, and the CONNECT public-private partnership (https://www.connectnorway.org) for PCM implementation with 28 partners (16 pharma & biotech, 9 public and 3NGO partners) that provides a forum for policy discussions of reimbursement models and regulatory framework. Key learnings include how to build nation-wide initiatives, the importance of aligning top-down instructions with bottom-up approaches navigating politics and policies at multiple levels, that health economics and reimbursement models are necessary aspects and the need to understand different corporate cultures and create win-wins to make a public-private partnership work. Unique aspects of our experience include the nation-wide initiative, reimbursement of the molecular diagnostics w. population effect, drug reimbursement in our PCM trial and the public-private partnership model.