Germany’s genomics-guided precision medicine national pilot project, genomeDE, is expanding after putting reimbursement and data storage infrastructure in place. The initiative has enrolled nearly 15,000 patients with rare disease or advanced cancer and plans to recruit more than 100,000 by 2029. The project is funded with up to €700 million from Germany’s public health insurance system and is designed to test whether integrating genome sequencing into routine healthcare is clinically useful and cost-effective. Organizers said participating clinicians and researchers will soon gain access to the platform data, while future steps include opening access for outside investigators. Regulatory and governance coordination across Germany’s federated healthcare and research landscape has been central to execution, with leadership citing stakeholder alignment and harmonized sequencing workflows as key constraints.