Before healthcare providers (physicians) can start employing pharmacogenomics in treating patients with drugs, pharmaceutical companies will need to include in their clinical- study protocols observations on how drugs interact and influence genes, how specific gene-based conditions are influenced by the drug under investigation, etc. In the absence of knowing in detail the genetic make of patients, and not knowing how a drug interacts and influnces genes, all the physician has at his disposal is a "black box".

Answers to these questions are easy.
Two initiatives that relate to this topic started recently. Precision Medicine Initiative - a partnership between the US government, some big pharma companies and some charities - addresses the issue of learning more about diseases and about overall living conditions that contribute to disease initiation and progression. However, it does not plan to develop therapies; that task has been left squarely and without any reservation to pharmaceutical industry. Another initiative, Accelerating Medicine Partnership argues that drug development is slow because clinical studies fail too often, and aims to generate information about diseases, their models, etc. that would make failures less frequent. However, its focus is on diagnostics; developing future therapies using this new knowledge is again being left to pharma industry - the same industry that is claimed by many to be "too rich, too greedy, ...etc.).
I have argued repeatedly (see my recent publications on this) that Precision Medicine will need Precision Drugs, and that paradigm that has been used over decates for developing targeted drugs is wrong and needs to change.
There is clearly an opportunity for start ups to "break into this space" provided that they come up with new ideas that break up the existing "status quo", as you call it; I would call it stagnation.
The issue is funding. Government funding is available but allows only small steps to be made at a time, so progress is inevitably slow. Private or institutional investors as well as Pharma do not like to take risk, so "revolutionary" ideas are hard to fund.
And here is one more point to keep in mind. Developing products that would actually cure diseases would generate a problem - how would you price it? I guess another new paradigm would be needed...

Realizing the potential role of the pharmacist in pharmacogenomics through medication therapy management will require connectivity of pharmacists into the electronic health record infrastructure to permit the exchange of pertinent health information among all members of a patient's health care team. Addressing current barriers, concerns, and system limitations and developing an effective infrastructure will be necessary for pharmacogenomics to achieve its true potential.
To achieve integration of pharmacogenomics into clinical practice via medication therapy management, the pharmacy profession must define a process for the application of pharmacogenomic data into pharmacy clinical practice that is aligned with medication therapy management service delivery, develop a viable business model for these practices, and encourage and direct the development of health information technology solutions that support the pharmacist's role in this emerging field.

The lack of clinical practice guidelines and algorithms is an additional barrier to the translation of pharmacogenetics into clinical practice. Guidelines need to be robust, up to date, and consistent but also flexible so that they can be quickly revised to reflect new research findings. In order to facilitate developments in this field, regulatory agencies such as the FDA and the European Medicines Agency have published guidance documents. Clinical guidelines define only best medical practices and are often insufficient to change clinical practice. Therefore, multipronged approaches may be essential, such as regulatory changes that are coordinated with changes to clinical guidelines.

Applications of p-genomics is not a simple switch to be turned on and likely will take 10-20 years to be a standardized aspect of provider care. While some types of care, such as rare or cancer care have rapidly expanded the regular use of p-genomics there remains a large gap to reach more patients and providers for its effective along with economic use.
Many applications are still being developed, identified or refined so we remain on the early end of a long learning curve for applications.