Background: Non-small cell lung cancer is the leading cause of cancer death. Significant survival gains have been achieved due to precision oncology, which involves testing for molecular markers that indicate sensitivity to targeted therapies. Precision oncology is essential to high-quality lung cancer care, but shortfalls in biomarker testing and targeted therapies limit improvements in lung cancer outcomes. We sought to characterize barriers and facilitators to precision oncology in academic and community practice settings. Methods: We conducted a mixed methods study on the delivery of precision medicine for patients with advanced lung cancer, including use of next generation sequencing (NGS), liquid biopsy, and targeted therapies, and the barriers and facilitators to effective delivery. Surveys and semi-structured interviews were conducted with a purposive sample of patient navigators, pathologists, and clinicians. Participants were recruited from community and academic settings in North Carolina (NC), using the NC Oncology Navigation Association and existing research networks. Results: Thirty-two participants completed the survey—9 navigators, 10 pathologists and 13 clinicians—with representation from community and academic sites. Five participants completed interviews—2 navigators, 2 pathologists and 1 clinician. Knowledge gaps about precision medicine were observed, with clinicians answering “not at all” or “a little bit” knowledgeable about NGS (23%), liquid biopsy (38%) and targeted therapies (23%). Navigators indicated feeling “somewhat” or “very” uncomfortable discussing these topics (55% for NGS, 44% for targeted therapies), and indicated having limited confidence in resolving barriers related to precision medicine. In interviews, potential solutions were highlighted, including use of financial aid from pharmaceutical companies, dedicated molecular pathology support, and partnership with social work and financial navigation to resolve barriers. Conclusions: Clinicians and navigators report gaps in knowledge and confidence in discussing precision oncology in advanced lung cancer. Qualitative data highlight several potential strategies for improving access, including addressing financial barriers. These findings suggest a need for education and financial assistance to support delivery of precision oncology in advanced lung cancer.