Made to order: Chemo drugs from Onekawa

Behind a plain white door, in an innocuous looking building set down an ordinary asphalt driveway in Onekawa, there’s a hive of industry going on. And the primary goal is to make sure that Kiwis sick with cancers and other illnesses have speedy access to the best drugs available. Photos: Tom Allan

It’s like something out of ‘Breaking Bad’. Men and women clad in head to toe hazmat suits, gloves and masks, diligently measuring and mixing highly sensitive substances behind layers of protective glass. To the rear of them, and on the other side of a second thick window, is a room housing what look like enormous tumble dryers.

This is iMIX, an aseptic compounding plant in Napier, founded by Jeremy Egerton. And if you don’t know what aseptic compounding is, you’re not alone. “It’s a very niche industry,” begins Jeremy – a Southlander who fell in love with a Hawke’s Bay girl and moved to Napier in 2017.

Aseptic compounding is the mixing of medicines to produce personalised medications – in this case, chemo and immunotherapy drugs. “We take orders from DHBs as well as private clinics,” explains Jeremy. “Each order is patient-specific, with doses based on his or her weight and height. We will compound the medicine when we receive the order, and put it on the courier so it’s delivered to the patient for their treatment the following day.” iMIX isn’t the only company compounding chemotherapy treatments, but Jeremy’s is definitely the most interesting, with a commitment to being more nimble than, and “deliberately different” to the multinational drug companies in this space. “The pharmaceutical companies can’t deal with individual orders like we do – instead, they’ll mass produce medicines at particular levels of concentration and each patient will need a specific dose of that compound. With the service we provide and the way we do things, the patient is more than just a number.”

Jeremy only began his business three years ago. He’d studied pharmacology and biochemistry at the University of Otago, then moved to Melbourne to work at a small family-run compounding business, starting off as a technician. Travelling on to London, he managed large aseptic compounding units in London hospitals and after he returned to New Zealand, helped a DHB build one before branching into consultancy. “I guess all that experience gave me the confidence to have a crack at something of my own,” he says.

So he went to Canopy Cancer Care, New Zealand’s leading private medical oncology provider, with a proposal. And that proposal resulted in the establishment of iMIX, with a model that split the business 55/45 – the majority holding to Jeremy.

He needed Canopy capital to even consider going into the aseptic compounding game, he says, “because the barrier to entry is huge. The equipment isn’t cheap, and then you’ve got stacks of regulatory and health and safety requirements.” Indeed, the compounding rooms are positively pressured, so that air can leave the room without being drawn back in from the outside. The chemicals can be dangerous when handled incorrectly, so there’s an emergency shower room, and those aforementioned hazmat suits, the height in pharma-cool fashion.

The other advantage to partnering with Canopy was brand equity. “In the chemo game, you’re mostly dealing with DHBs, who are notoriously risk-averse, so to have the backing of a known entity was important.” iMIX started by servicing the Canopy clinics (they’re active in Auckland, Tauranga, Whangarei and Hawke’s Bay) and as their reputation grew, so too did the number of orders flying out the door to patients having their chemotherapy treatment at a range of other major clinics and hospitals New Zealand wide.

There were some hiccups in the start-up phase, and Jeremy admits to a few sleepless nights when his entire compounding operation was set up and ready to go, staff were on the payroll, but he hadn’t yet had the seal of approval from Medsafe to trade. Watching the bank balance dwindle with absolutely no way of making a cent was “stressful, nerve wracking. It got pretty borderline there for a

“The pharmaceutical companies can’t deal with individual orders like we do – instead, they’ll mass produce medicines at particular levels of concentration and each patient will need a specific dose of that compound. With the service we provide and the way we do things, the patient is more than just a number.”

moment,” he admits. And when certification finally arrived, it was “all hands on deck just to get orders out the door. Back then,” he muses, “we thought 30 or 40 orders was a big day.”

In fact, when Jeremy first shot images for his iMIX website, he only had three staff. “We had the photographer take the photos in such a way that we looked like we had heaps more!” he recalls with a smile. If he needed to refresh his site in the future, he’d have no shortage of models, with a current staff of 35. And they’re mixing upwards of 250 orders each day.

In fact, iMIX is so successful, you’d wonder why there aren’t other startups giving aseptic compounding a red-hot go. But there’s an easy answer. “You need expertise, and you need a lot of money, and that’s probably why it’s been the domain of Big Pharma for so long.”

Canopy, TRG Imaging and iMIX are now all part of one parent group with their end goal to help smoothe the patient journey, from diagnosis to treatment. “The idea is to offer a seamless, integrated approach so that, amid the shock of a diagnosis, a patient doesn’t have to worry about bouncing from one provider for a scan to another for chemo,” Jeremy says. “What we’d like them to hear is, ‘You’re already booked in to get your imaging done – and you’ll see your oncologist next Wednesday.’ It’s always going to be a traumatic time for a patient, but we want to make it less stressful, if we can.”

However, to a patient receiving chemo or immunotherapy that has been compounded by a Hawke’s Bay technician at iMIX, there’s very little to distinguish what’s hanging on their IV pole from something compounded by one of the multinational drug companies. It’s possible a nurse or DHB staff member might mention it. “We’re told that patients are often quite fascinated to find out their chemotherapy was made by a small company founded in New Zealand.”

Or, more likely, they’ll see a flash of packaging or a smidge of branding. Jeremy says that why he’s deliberately chosen a cheerful colour palette and friendly logo to market iMIX. “We didn’t want anything sterile or clinical – nothing blue and white!” he laughs. So, chemo infusions come in black non-PVC bags with a bright strip, and the iMIX logo – like everything the company does – is patient-centric. “If you look closely, you’ll see the X is actually a person.”

Jeremy – engaged to Jo and with three gorgeous daughters – is a man who isn’t keen on blowing his own trumpet. In fact, he’s never done a media interview before, and finds the interest in iMIX rather curious.

For him, the priority is keeping his business human-centric, socially conscious, and for the team working here to have fun, learn and grow. “We try and recruit locally wherever we can and to take people on a bit of a journey – we can train just about anyone to work with us.” So far, it’s working well. “The team we have on board is a really passionate group who go above and beyond to make sure that all patients get their treatment on time. We’re stoked with our crew.”

So what’s next for iMIX?

Since inception, Canopy’s taken a larger stake and Jeremy a smaller one, but he’s at pains to point out that it doesn’t change his vision. “We’re never going to go down a highly corporate route – we’re a company servicing a domestic clientele and have clear values around that.”

And demand is growing still. More and more DHBs are switching to iMIX and enjoying the service, which, in turn, enables iMIX to bring further innovative integrated solutions to market. “We’re set up nicely for the transition to Te Whatu Ora (Health NZ),” says Jeremy. “And we’re looking at opportunities for other alternative models to bring additional savings to the New Zealand health sector.”

As for shipping or flying medications to other countries, Jeremy says it’s unlikely. “Moving compounds across borders is hard,” he explains. “But New Zealand’s not the only country with a broken health system and I think there are other opportunities, for sure. If you can design a new model that works, there’s no reason why it can’t be applied elsewhere.”

If anyone can do it, it seems more than likely Jeremy Egerton – the young, unassuming pharmacologist who dreamed of a better way to serve cancer patients and made it happen – will be having more excellent aseptic compounding adventures in the future.

“It’s better to try and to fail than to never try – and I’d never want to die wondering,” says Jeremy. “And healthcare as an industry is stable and growing so you don’t get the booms and busts you might with other sectors like tourism or property. It’s a good place to be.”

But for now, what he’s most proud of – and most invested in – is the small improvements he’s making, daily, to those with cancer diagnoses.

“To provide life enhancing treatment to thousands of New Zealanders while delivering savings to the public health system is something I’m really pleased about,” Jeremy concludes. “That, and the vibe and the values we’ve created right here in Napier.”

“New Zealand’s not the only country with a broken health system and I think there are other opportunities, for sure. If you can design a new model that works, there’s no reason why it can’t be applied elsewhere.”

Fiona Fraser is the director of Contentment PR & Communications. Nominate a savvy entrepreneur to feature in an upcoming column by contacting fiona@contentment.co.nz