On paper, the global OTC market is in a strong position, forecasted to grow steadily to 2032. Yet this growth is set to be uneven and harder to pin-down, driven not just by geographic shifts – Europe and Latin America are set to lead this growth through 2030, with North America comparatively stagnant – but a fundamental shift in who controls the industry’s direction.

The consumer is now leading rather than following, taking charge of their health pro-actively and adopting a prevention mindset, rather than just treating symptoms when they appear.

This shift should force a rethink in strategy when it comes to expanding a consumer health brand into new markets, yet too many brands still treat expansion as a geographic question — which markets to enter, which channels to activate — rather than a translation challenge.

The real task is not just to move into new markets, but to carry a brand’s logic, positioning and execution into environments where consumer behaviour, retail structures and regulatory conditions differ in meaningful ways.

The consumer is now dictating the terms

The defining shift in consumer health is not simply digital adoption or channel fragmentation. It is the transfer of control. Consumers are now actively managing their own health, supported by constant access to information, digital tools and emerging forms of guidance.

This has two consequences. First, demand is no longer episodic or purely needs-based. It is continuous, informed and often self-directed. Second, it places pressure back onto brands to meet consumers in much more fluid ways, across multiple channels and decision points.

The industry has responded by expanding its capabilities - more channels, more data, more touchpoints, more specialization - but this response has come at a cost. What was intended to increase reach and precision has often resulted in operational complexity.

It is this increased complexity at the operational level which is the key tension that sits at the heart of most growth challenges today.

Why expansion creates fragmentation

Most brands understand that growth requires scale, but fewer recognize what scale does to the system behind it.

As portfolios expand and markets multiply, decision-making can fragment, with operational functions moving forward but not always in the same direction. The gaps this fragmentation creates is where the growth expansion was supposed to create gets lost.

While, the instinctive response is to add structure to wrangle functions back together - more processes, more teams, more control - this tends to compound the problem rather than resolve it – introducing more complexity, slowing decision making and grinding progress to a halt.

The issue is not scale itself, but the absence of a model that can connect decisions consistently across that scale.

What successful expansion looks like in practice

The difference becomes clear when looking at how successful expansion is actually delivered across differing expansion ambitions.

Scaling quickly tends to expose where a model is weakest. When Breathe Right was taken from acquisition into more than 20 markets in a matter of months, the risk was not execution speed, but fragmentation.

Without a way to connect decisions — from due diligence through to market onboarding and execution — rapid expansion typically results in drift. What held was not process, but structure. A single, integrated delivery model built and executed by IQVIA Consumer Health’s Commercial Outsourcing team aligned commercial, brand and operational decisions, allowing the brand to move at pace without losing coherence and ensuring Breathe Right was successfully introduced into over 21 markets worldwide within 6 months.

A different risk emerges when brands assume transferability. Fisherman’s Friend entering the US could have scaled what already worked. Instead, it confronted a more fundamental question: whether that model would translate at all.

The complexity here was not operational but strategic, with the consumer expectations, retail dynamics and competitive context of the US market demanding a different answer to the same questions where the brand was already successful. Resetting the proposition around a clearly defined US consumer, and building the go-to-market approach from that foundation, reduced the risk of scaling the wrong model.

In other cases, the issue sits even earlier in the lifecycle. Norgine’s constipation brand Movicol faced the challenge of moving beyond its prescription heritage and becoming a consumer-focused OTC product. Scaling without resolving what Movicol stood for in the OTC world would have amplified inconsistency across markets and channels. To make that leap successfully, the company worked with IQVIA Consumer Health to define a single, clear consumer-facing positioning based on cross-market insights, and using that as the anchor for all subsequent execution.

Across each of these situations, the pattern is consistent. Growth was achieved by simplifying the complexity that can be created when expanding — creating a clear core, connecting decisions end-to-end, and building a system that could carry that coherence as it scaled.