Any commercial printing press will have capacity for CMYK ink plus multiple Pantone inks. A machine called a raster image processor reads say a PDF and generates individual printing plates for every color specified by the designer/client. A designer will apply Pantone color stickers to the ink jet or laser printout that the designer sends along with the digital file so that the print shop can prepare the printing plates and Pantone inks for the job. A machine like the automated paint mixers in a hardware store are used to mix up Pantone inks that a print shop doesn’t have on hand. There’s obviously an upcharge for custom inks which the cost is tacked into the bill. Clients will fire a designer for allowing the wrong Pantone colors to go to press. If a Pantone code is in the specification doc isn’t used by the print shop, the print shop will eat the cost of the mistake. There’s a “nobody got fired for choosing Pantone colors when it matters” mentality amongst designers and printers.