Good day. Welcome to Perrigo's fourth quarter and full-year 2019 financial results conference call. All participants will be in listen-only mode. Should you need assistance, please signal a conference specialist by pressing the star key followed by zero. After today's presentation, there will be an opportunity to ask questions. To ask a question, you may press star then one on a touch-tone phone. To withdraw your question, please press star then two. Please note, this event is being recorded. I would now like to turn the conference over to Brad Joseph, Vice President, Investor Relations. Please go ahead.
Thank you. Good morning, everyone, and welcome to Perrigo's fourth quarter and year-end 2019 earnings conference call. I hope you all had a chance to review the press release we issued earlier this morning. A copy of the release is available on our website. Joining today's call are President and CEO, Murray Kessler, and CFO, Ray Silcock. I'd like to remind everyone that during this call, participants will make certain forward-looking statements. Please refer to the important information for shareholders and investors and safe harbor language regarding these statements in our press release issued earlier this morning. When discussing our business, Murray will reference only non-GAAP adjusted numbers unless otherwise stated. All comparisons of prior periods will also exclude currency changes. Ray's discussion of financial results during this call will address both GAAP and non-GAAP results.
In the appendix for today's call, we provided reconciliations for all non-GAAP financial measures presented. Couple of other quick items to note before we get started. One, exited businesses means the exited animal health and infant food business. Two, non-GAAP net sales excludes the exited businesses from both 2018 and 2019, and for the full-year comparison, also excludes the voluntary global market withdrawal of ranitidine in the third quarter of 2019. Three, organic growth excludes Ranir, the exited businesses, and currency changes. We'd also note that the company realigned its consumer product categories to standardize reporting and evaluation across its worldwide consumer businesses, which you can see in the appendix attached in this morning's press release. These updates have no impact on the company's net sales and are provided by quarter for fiscal 2019. With that, I'd like to turn the call over to Murray.
Good morning, everyone. I'm pleased to share that following a good third quarter, Perrigo's business sequentially strengthened in the fourth quarter of 2019 of the year. We believe multiple quarters of improving fundamentals demonstrates that Perrigo is executing well against our new consumer self-care strategy, and that our transformation initiatives are working. Of course, we're only nine months into a two to three-year transformation, there's still much work to be done. The drivers of growth, the quality of growth, and the breadth of growth across businesses in Q4 provide strong evidence that we are on the right track to deliver our stated three, five, seven long-term growth goals. Starting with revenues, as compared to a year ago, the company hit on all cylinders in Q4. Total Perrigo consolidated net sales grew 13.4%.
All segments contributed to this growth, including a 19.4% increase in Consumer Self-Care Americas, CSCA, an 11% increase in Consumer Self-Care International, CSCI, and a 2.2% increase in generic Rx. Total worldwide consumer revenues grew 16.4%, including the additional revenues from the Ranir Oral Care acquisition. Excluding Ranir, organic growth in the fourth quarter was very strong, with CSCA up 10.6% versus a year ago, and CSCI up 4.3%. This brought total consumer organic growth to 4.7% in the second half of fiscal 2019 and 2.2% for the full-year. This gives us even more confidence that we can deliver on our stated 3% organic growth objective. A closer look at the drivers within our business segments should help you understand why we say the quality and breadth of the fourth quarter results I just referred to were so strong. Starting with Consumer Self-Care Americas.
CSCA adjusted Q4 net sales growth of a very strong 19.4% was driven by, first, $52 million in incremental domestic Ranir sales, representing 45% of Q4 total CSCA year-over-year growth. Two, $42 million in OTC sales growth, representing 37% of Q4 total CSCA year-over-year growth. All CSCA OTC subsegments enjoyed strong Q4 growth, including cough, cold, +5%, allergy, +19%, digestive health, +5%, pain, +9%, and healthy lifestyle, +10%. When I refer to healthy lifestyle, think nicotine cessation in the U.S. Four factors contributed to this broad strength, and importantly, one potential factor didn't. First, the product categories we compete in grew at a faster pace in Q4 2019 versus Q3.
3.3% growth versus 1.8%, or almost double in the fourth quarter, benefiting from strong cold, cough, and allergy seasons, as well as developments in the tobacco industry that we believed encouraged increased attempted quitting by smokers and vapers. Second, total Q4 store brand penetration versus national brands increased 70 basis points, and concurrently, Perrigo gained share from other store brand competitors as a result of new product launches and distribution gains on existing products. That is to say, Perrigo got a larger share of a bigger slice of a bigger pie. Third, it is noteworthy that Perrigo's e-commerce business has gained sufficient scale so as to become a meaningful growth contributor. E-commerce represented a quarter of the $42 million in total OTC organic sales growth for the quarter and has generated an incremental $30 million in sales for the year.
We believe Perrigo's rapidly developing expertise in e-commerce is quickly becoming another competitive advantage. The fourth driver of total CSCA's strong quarter was our nutrition business unit, which returned to growth as predicted on our last call. Perrigo Nutrition was up 21% versus a year ago and represented about 17% of total CSCA growth. The business enjoyed robust growth behind the launch of a new product to a large customer and a return to strong contract pack sales as we work through the previously discussed inventory issue. Some of the strength in Q4 nutrition contact sales was timing related to production planning in advance of a new retail product launch in Q1. We expect to give a bit of the contract pack sales back in Q1, but even adjusting for this, nutrition still grew double digits in the quarter.
Fifth, the one factor that importantly did not impact sales for the quarter was increases in trade inventory. To be clear, trade inventory positions at the end of 2019 were at a lower level than the prior year, which bodes well for the first quarter of 2020. Strong revenue growth and increased adjusted gross and operating margins resulted in a 20% increase in adjusted operating profits for total CSCA. We enjoyed solid adjusted operating income increases despite significant transformation investments in the quarter. Turning to Consumer Self-Care International. Q4 net sales increased 11% versus a year ago. CSCI's results benefited from $22 million in incremental sales from Ranir, combined with solid organic growth of 4.3%. Organic growth in CSCI was driven by $23 million in new product launches, including the XLS-Medical Forte 5 and Phytosun launches, and good selling activities for the cough-cold season in Europe.
EU markets category consumption for OTC remained solid, growing at an attractive 3% to 4% rate, with Perrigo's portfolio of regional brands maintaining their collective market share. Finally, our U.K. store brand business realized strong growth. This, combined with the addition of Ranir, means our store brand business now represents a larger percentage of our total CSCI portfolio. As store brands carry lower gross margins, our gross margin for CSCI was negatively impacted. However, this reversed itself at the operating margin line as store brands carry almost no A&P. Bottom line, CSCI adjusted operating margin increased 100 basis points year-over-year, and the business delivered 16.4% adjusted operating income growth for the quarter. Finally, our generic Rx segment continued to outperform most other generic Rx companies, posting 2.2% net sales growth despite comparison to last year's launch of testosterone 1.62%.
Rx growth came from higher volumes of existing products and $19 million in new product sales, partially offset by pricing pressure and discontinued products of $6 million. Total adjusted operating income for Rx was down 26.3% for the quarter, due primarily to the testosterone 1.62% comparison. On a consolidated basis, Q4 adjusted EPS increased 9.3% versus a year ago. Adjusted EPS for the year 2019 finished at $4.03, which was above our original May 9th guidance, and it included $25 million in transformation investments. In summary, I am very pleased with the quarter. It's what I like to see. The team is executing well, which is translating to solid fundamentals on our business. I'm proud of the Perrigo teams all across the world. They are energized and winning again.
All of us believe that we are recapturing the Perrigo advantage and are confident that we will make lives better by bringing quality, affordable self-care products that consumers trust everywhere they are sold. I'll now turn the call over to Ray Silcock, our Chief Financial Officer, to cover the financials in more detail, and then I'll return to make a few go-forward comments regarding guidance. Ray?
Thank you, Murray, and good morning, everyone. Now that Murray has gone through the highlights for the quarter, I'd like to walk you through the rest of Q4 P&L with a brief look at the full-year 2019. Consolidated reported GAAP net income for Q4 was a loss of $19 million, and reported diluted loss per share was $0.14. Consolidated adjusted net income for the quarter was $145 million, and adjusted earnings per share were $1.06, marking our fifth consecutive quarter of meeting or exceeding market expectations. Adjusted net income includes $164 million of non-GAAP adjustments that we added back, including non-cash impairment charges of $142 million, primarily driven by a lower valuation of the Rx business due principally to market and industry factors, amortization of $80 million, which we always add back, all partially offset by a $50 million tax adjustment.
The GAAP reported consolidated effective tax rate for the fourth quarter was 44.5%. This was generated from a tax benefit of $15 million and a loss before taxes of $34 million. The income tax benefit was due primarily to a valuation allowance release in the U.S. The loss before taxes was principally due to the $142 million of impairment charges recorded in the quarter, which were nondeductible for tax purposes. After adjusting for these and other non-GAAP adjustments, our effective tax rate for the quarter was 19.5%. Full details of all these adjustments can be found in the non-GAAP reconciliation table attached to this morning's press release. From this point forward, all my dollar numbers are on a non-GAAP basis, while growth percentages will be in constant currency and exclude exited businesses.
First, I'm going to review the results of our worldwide consumer business, which is comprised of the Consumer Self-Care Americas, Self-Care International segment, and corporate unallocated expenses. Afterwards, I'll discuss the Rx segment. Worldwide consumer sales growth in the fourth quarter was up 16.4% from prior year. Gross profit increased $51 million- $419 million, or 18% increase, excluding the impact of currency and exited businesses. The acquisition of Ranir accounted for half of the gross profit increase, while strong performances by the U.S. OTC and nutrition businesses, as well as successful new product launches in both the Americas and international segments, were responsible for the rest. Gross margin was up 40 basis points from 38.9% - 39.3%.
CSCA's gross margin was up 190 basis points from the impact of the sales flow-through, including growth in the allergy and smoking cessation categories, gross margin leverage and operational efficiencies, which more than offset a 180 basis point decline in CSCI, primarily due to the addition of Ranir, whose store branded business has a lower gross margin, but a stronger operating margin due to there being almost no advertising and promotion in store brands, as well as adverse product mix. While gross profit was up $51 million, operating income improved by $41 million, primarily due to the impact of a $12 million expense to restore employee bonuses and reflect 2019 performance. Total operating income was $153 million, up 36.5% on a non-GAAP basis. Turning now to the Rx segment.
Net sales growth in Q4 was 2.2%, but gross profit decreased by $11 million in Q4 to $111 million, and gross margin of 43.2% was down from 49% last year, due primarily to adverse pricing, specifically of testosterone 1.62%. Operating income was lower by $22 million - $62 million. Operating expenses were up $11 million, primarily for pre-commercialization R&D costs of generic ProAir. These were principally units of generic ProAir that were made during 2019. We now have approval from the FDA, these units will be sold and will have a lower cost of goods, providing us a benefit in 2020. A few quick remarks about our full-year results. Worldwide consumer net sales were up 6.3% and gross profit increased versus 2018 by 4.1%.
This improvement was driven by the addition of Ranir from July 2019 on, albeit at a lower gross margin profile, and by strong performance of the U.S. OTC business. Operating income decreased $47 million- $545 million. Excluding the impact of currency and exited businesses, operating income was down 3%. Despite gross margin flow-through, the year-over-year decline was driven firstly by $25 million of investments to support innovation and future sales. Secondly, by the $37 million cost of restoring employee bonus programs, which were at a low level in 2018. Thirdly, by a $17 million insurance recovery in 2018 that did not recur in 2019. For the full-year, the Rx segment net sales were up 5%, but gross margin declined by 600 basis points, driven by downward pricing pressure from competitor approvals.
Operating income was lower by $41 million due to pricing and the pre-commercialization expense related to ProAir. In summary, our consolidated earnings per share for 2019 were $4.03, in line with Wall Street expectations. With respect to our balance sheet, as of December 31, 2019, total cash on the balance sheet was $354 million, and total outstanding debt was $3.4 billion. 2019 cash flow from operations was $388 million, a 71% cash conversion on adjusted net income. This lower-than-anticipated ratio was driven by a higher trade accounts receivable, primarily in the Rx business, which we expect to return to normal in the first half, as well as by Israeli withholding tax payments of $32 million made in Q4. Before I turn the call back to Murray for him to talk about our 2020 guidance, a brief word on the potential impact of the coronavirus.
Obviously, the situation continues to evolve, but currently, we don't anticipate it having more than a modest impact on our results. Most of our manufacturing facilities are in the U.S. and Europe, although some of our products are manufactured, and we source raw and other materials from around the world, including in China. All of the plants in which we manufacture and from which we source our products are currently running. While we have incurred small incremental air freight costs to date this year, we don't expect these to have a material impact on our results in Q1. Based on what we know today, we don't expect more than a modest impact on our fiscal year. With that, I'd like to turn the call back to Murray.
Thanks, Ray. Looking forward, the company has momentum as we enter 2020, and we are encouraged by the transformation results so far. The fundamentals on our worldwide consumer business are solid. We have a strong lineup of new products across the portfolio. Our e-commerce business is becoming an increasingly important source of growth, and we expect our revenue-accretive bolt-on acquisitions, including this week's acquisition of Dr. Fresh, to further accelerate future organic growth. We also have finally received approval on generic ProAir. We expect these actions to deliver approximately 6%-7% reported revenue growth for total Perrigo in 2020, with organic growth right around the 3% target. You might expect this strong revenue growth to translate into higher adjusted EPS than the $3.95-$4.15 guidance range provided in this morning's release, which is only slightly higher than a year ago.
Our guidance includes exited businesses and several structural cost increases. Remember, we are only just completing the first year of our transformation, and there is still much to do to recapture the Perrigo Advantage. As planned from the beginning, our transformation plan invests $50 million in 2020, $30 million incremental, split pretty evenly across building out new channel infrastructure like e-commerce, innovation like Nasonex, technology business intelligence systems, and Project Momentum-enabling technologies. Absent this investment spending, we believe our adjusted operating income growth would be close to the plus 5% we are working towards for 2021 and beyond. Worldwide consumer net sales are projected to follow their historic pattern. That is spread pretty evenly across quarters, with some seasonality increase in Q4 for the beginning of cough, cold, and allergy seasons. It should look pretty much like this year.
I would note that we do expect a meaningful decline in Q1 Rx adjusted operating income versus 2019, similar to what we saw in Q4, and for the same reason. The expiration of the 180-day exclusivity period for testosterone 1.62%. With the launch of generic ProAir, total generic Rx operating profit and revenue is expected to be up for 2020, despite the decline in Q1. Perrigo capital spending for 2020 is estimated in the range of $175 million-$225 million, also reflecting investments for increased capacity and Project Momentum-enabling technologies, as well as normal maintenance projects. Importantly, we expect to complete several key transformation projects this year that are necessary for us to sustainably win in the marketplace and deliver long-term profitable growth.
On a final note, I'd like to thank Jeff Needham, President of our Consumer Americas Business, who announced he will be retiring later this year after 36 years of leadership at Perrigo. Jeff is an icon in the store brand industry and is loved by his colleagues at Perrigo and across the industry. He leaves CSCA in strong shape with a great team, and he will be transitioning the business to Rich Sortoa, CEO of Ranir, who will become President of CSCA in March to enable enough transition time prior to Jeff's departure. Rich is experienced and fully aligned with our consumer self-care strategy. CSCA is in good hands. Operator, we will now take questions.
We will now begin the question and answer session. To ask a question, you may press star, then one on your touch-tone phone. If you're using a speakerphone, please pick up your handset before pressing the key. If at any time your question has been addressed and you would like to withdraw your question, please press star then two. Our first question comes from Gregg Gilbert with SunTrust.
Hi, good morning.
Hey, Gregg.
I'll ask them right up front for you. Hey, Murray. Just to follow up for Ray on the cash flow from ops. I think that number came in over $100 million below your guidance from August. You detailed a couple items that seemed like they were one-time in nature, can you talk about anything that changes your view on sort of cash flow conversion on a more sustainable basis? I was hoping you could provide a little color on the latest acquisition in terms of the existing growth rates and margin structure of that business. Lastly, Murray, I'm curious about the Voltaren Gel opportunity. It's a product you sell in Rx today, Glaxo or GSK is taking it OTC. I think that's an interesting opportunity longer term for Perrigo.
Maybe you can talk about how an example like that moves from Rx to OTC for you, can help or hurt. Thanks.
I like how you positioned the last question, but go ahead. We'll come back to that one. Ray, you want to do the first part on that?
Sure. Yeah, no, we were well below. That's why I called it out, Gregg. The big thing was that on our Rx business, our trade receivables jumped, and it's a structural thing, timing, and we will get it back at the beginning of this year. We're getting it back already, in fact. It'll mainly be back in the first quarter, some in the second. The other thing was Israeli withholding taxes, and that was a one-time payment. We had some cash trapped in Israel, and we de-dividended it out and paid the $32 million of withholding taxes related to that.
Dr. Fresh. Just so you know, in this guidance, this all happened this week. We have very conservative numbers in for Dr. Fresh. We have to extract the business out. There's some TSA services we're gonna need to pay. I haven't put in a lot into the projection. There's a little bit there, but I think the important part for people that are looking at this transaction, and if you look at the total transaction cost, the bulk of which was paid by us, is because Dr. Fresh was the healthiest and strongest and best performing piece of that portfolio, and frankly, the rest of it would've been non-strategic for us. We found a partner who's very interested in cleaning up and dealing with the issues on the balance of the business.
For us, Dr. Fresh has been a relatively stable business that Ranir tried to buy for significantly more money a couple of years back. When you put the two businesses together, we believe that there are significant, not just cost synergies, but given the capabilities of Ranir versus Dr. Fresh to broaden that product line relatively quickly. It's a great business that's at important customers, that is completely incremental. A big portion of that business is in the kids segment, and they're the leader in that segment. We have the capability of bringing a number of technologies, power, and things like that at a much more advanced level to that business. There's not much in there right now. Maybe there's some upside on it. We'll see as the year progresses. We like the business very much, and we got it at a great price.
On the Voltaren Gel, there's nothing in our guidance on that right now. I heard your loaded part of that question about the benefit of having Rx. It was. Yeah, I'm not gonna deny that. That gives us a huge leg up, and I'm not sure today. We're waiting to hear, and we'll hear shortly, hopefully over the next couple of months. That could be a 2020 opportunity. That depends on sort of what the rulings are on exclusivity, et cetera. We make it today, we could be out very quickly. We'll watch that one. It's a big switch, and I don't want to derail from your question, but a year ago, when I was talking about Rx OTC switches, I kind of didn't even plan on any of those in our three, four-year horizon.
That whole area, Voltaren, some of the things talked about by our competitors and some very big categories, gives me some excitement that there's another avenue for growth that I wasn't planning on. We'll keep you posted on Voltaren, but it's a big product. We can do it right away. Depending on how the FDA rules on it, we'll let you know in an upcoming quarter like at all.
Thank you. Next question.
Our next question comes from Louise Chen with Cantor.
Morning, Louise.
Hi, good morning. Thanks for taking my questions here. You highlighted the importance of e-commerce a few times in the call this morning. Just curious, where is that business for you today, and where do you want it to be over the next few years? The second question here is, in addition to ProAir, what are some other notable launches that you've included in your guidance for 2020? The last thing here is just on M&A. How important is it for you this year? How much capital do you have to deploy towards M&A? Any particular areas you're interested in? Thank you.
Let me start the answer by saying, as I've been here a year and I hone down on our strategy, I've kind of come to the conclusion that we're gonna put the pedal down on five product growth priorities. Core OTC, nicotine, naturals, oral health, and nutrition. That's where I look at we need to build out. In order to do that, and where our investments have been coming on kind of seven growth enablers. Building out our e-commerce and digital capability, accelerating innovation, adding bolt-ons back into the mix as you saw, strengthening our consumer skills and analytics, more aggressively going after white space opportunities around the world, minimizing the negative of price erosion, and the final one being making investments in capacity, et cetera, and Project Momentum type initiatives to help drive costs down. That's kind of the big picture of cost.
It changes depending on each of those different product segments, the role of bolt-ons. We probably evaluated, in my first year here, 50 bolt-on acquisitions that ultimately got down to seven or eight that we showed some initial interest in to do due diligence in, that culminated in four transactions so far. All in the definitions that we talked about through the course of the year at various presentations and our priorities. Bolt-ons will continue. The impact of bolt-ons this year versus last year is significant. You had basically $150 million half of Ranir. You get that half added to this year, the Dr. Fresh, which again, I'm conservative by nature, so I haven't put a lot in. That gets added in the Prevacid that is launching and off to a good start, gets added into that as well.
SteriPod that we also just bought will go in and contribute. I can't give you a direct answer because I don't buy it to fill a gap. Our innovation programs have ramped up significantly in each of those areas, and e-commerce represented. It's getting to be real now. It represented 40% of our OTC growth in the U.S. last year, and it added a $30 million. When I add Europe, it's well over a $100 million business that's growing close to 100%. It's a real driver. It goes against each of those various product categories, some more than others. What I'm pleasantly surprised with is we're not seeing. If I told you e-commerce growth, you might sit there on the other end of the line and say, "Oh, you're talking Amazon." Amazon was a quarter of that growth.
It was really spread out among traditional customers, some direct-to-consumer customers. It is an area we put a lot of emphasis on. I believe it's a competitive advantage, and it's an area we'll continue to press and make, and it's a meaningful part of that $50 million in investments that I talked about. Did I get all your questions? You asked a lot.
Yes. I think the other one was new products, how much the new products was included in the guidance for this year.
Was it total new products or restate? Can you give me the question again on new products, Louise?
Yeah, sure. In addition to ProAir, what are some of the notable new launches that you have incorporated into your 2020 guidance?
Well, for competitive reasons, I'm not going to tell you the ones that haven't launched. It's a secret. We have talked pretty aggressively about that a big driver of our nutrition business was to infant formula new product launch that went to a specific customer. I won't say that for competitive reasons as well. That's a big new item launch, and that is baked in. It was in the fourth quarter, drove a lot of the growth that you saw in the fourth quarter. You should have nine months of incrementality of that for 2020.
We have a second infant formula launch, which is the hypoallergenic. That one's already been sold into customers. That is what I was referring to in my comments that we had to make some of our co-pack inventory in the end of the fourth quarter, because when you run the hypoallergenic product, nothing else can run. You literally have to stop, shut down, clean the whole facility, to keep that product hypoallergenic. That's just our normal scheduling types of things. Our program is loaded. We have a more robust new product innovation program in 2020 than we did in 2019, which was a major increase versus 2018. It's a robust plan. In the consumer business, it's different than the Rx type of business, depending on what you're used to analyzing, because it all gets down to the incrementality and economization.
We think we properly estimated that, and it'll play a big role. I'll show you those as we launch them, but they tend to be lots of them in different markets through Europe, in different categories, and they're not like a ProAir. Like this year when we went into fluticasone or we got back into some Mucinex-like products with guaifenesin. It's a very robust new product plan. I'm coming off as sounding like there's these tons of growth opportunities and I'm holding back. I think 6%-7% revenue growth from where this company was, and if I look back early in most of my investor meetings, everybody was disbelieving how we were going to get to 3% organic growth. Now the questions are coming on the other side of why can't it be higher? I guess that's a good place to be.
For those of you who know me, I'm conservative by nature.
Thank you.
Thanks, Louise. Next question, please.
Our next question comes from Chris Schott with JP Morgan.
Morning, Chris.
Good morning, thanks very much. Good morning. Just two questions here. I guess first on product innovation in consumer. I think you've talked about some of these NBB or brand different opportunities. I was wondering if you could a little more color in terms of how long you think it's going to take to build out a broad portfolio of those assets. Once they've been developed, do we need to think about incremental marketing spend to build awareness around those? Or you think just more shelf placement, et cetera, allows consumers to see some of the advantages of those opportunities? My second question was then on-- Oh, sorry.
No, it's all right. I got it.
I was gonna say, the second one was just on, I think you highlighted in CSCA, the acceleration of growth in the broader OTC market. I was just looking for a little bit more color about how sustainable you think that uptake is. Is this a pivot we're seeing to the market growing faster? Is this just, it was a strong quarter and we see kind of some normal quarter-to-quarter variability of growth of that kind of broader market you're competing in? Thanks very much.
Let's start with innovation. We're already starting to see NBB products hitting the market. There were NBB products that hit in nicotine. There was an NBB product in our GI category that was a good contributor this year. They're starting. In the world of where I truly want to get to, we still have a fair amount of work to go. I'm going to miss Jeff Needham tremendously. I will also say that coming in, Ranir has been very focused on NBB, and Rich and I are aligned with what could be an evolution of the sort of almost a hybrid model between a traditional branded company and a store brand company. You'll start hearing us use the term consumer 2.0, where we start customizing brands, not just necessarily store brands.
I think we're in the infancy of what it can be, but those tend to still be brands developed for customers. They don't add a lot of incremental spending. However, we buy a brand like Prevacid, part of our spending this year is that brand needs to be advertised and that is incremental. There are television commercials that are airing as we speak for Prevacid and being shot for the year and that's part of the investment as well. As we work towards the 5%, I've told this organization pretty clearly and the street pretty clearly that there were certain things I didn't want to just invest very quickly and then get a one-year wonder of getting operating profit growth and all. The goal here was to make the real changes and investment levels.
If last year we kind of reset things initially and got the volume growing by the end of the year, this year deliver the three on the three, five, seven. I know we're going six. Six,seven, but I'm talking more toward the organic side. From 2021 on, 5%. When we think of those investments, and there will be some meaningful ones, we're going to have to do that within the growth of the rest of the business. I wouldn't look at it and say those will be inhibitors to our ability to grow. Everything in this company is being geared to getting the things completed, Project Momentum, the technologies, the analytics, all in place, the e-commerce capabilities, the direct to consumer capabilities, all in place so that in 2021 and on, we're delivering the rest of our business model.
That means on a switch product like Nasonex, from the branded side or from the national companies, those take significant dollars, but we're gonna have to figure out a way to do that within and still deliver on our goals.
I think he had the second part of his question.
I know. I just spent so much time answering the first part, I forget the second part. The second part was the total OTC growth.
Yeah.
I get carried away sometimes. The second part was the total OTC. We refer to the core OTC versus total OTC, and I'm going to be talking more and more about that. If you're talking $6 billion of total OTC, our core categories that we compete in are around $3.8 billion of that. The penetration levels are higher. We gained 70 basis points. We were able to drive up to almost 38% penetration, which means that's real. There are certain things that could have driven a bit of growth that are seasonal, like it was a good cough cold season in the U.S. this fall. We'll see how that seasonality. In general, those weren't the big drivers. The big drivers on nicotine were, besides getting new products, placing and filling real consumer needs is, it's a tiny category relative to where I came from.
With the vaping problems that were out there and the minimum age of tobacco being raised from 18 - 21, I would expect that category to stay at an accelerated rate. A lot of the other categories, the new products that are coming in represent growth opportunities. The areas that we're pushing e-commerce is not even included in that 3%, or some of it. When something is selling through Amazon or direct to consumer, that's not even being captured in the traditional MULO number. It's probably a little bit more accelerated than that. I would think that most of them, the new products that drove on infant formula, that didn't drive the category. That drove our brands, but they'll be there all year long. The new products that we gained and the penetration that we gained, that should be there for the long term.
Categories go up and down over time. It's a long-term trend that this category's been growing 2%-3%, and I don't see healthcare costs getting any cheaper.
Thanks, Chris.
Great. Thanks for the color. Thanks.
Our next question comes from Randall Stanicky with RBC Capital Markets.
Great. Thanks. Murray,
Good morning, Randall.
Good morning. You talked about structural cost increases in your prepared remarks. Question is, how much of the $50 million in transformational investment is structural, or in other words, how much of that recurs going forward, and does that fall all into CSCA? The bigger picture question is, there's a lot of focus, or I think there's going to be focus around the margins going forward. If we look at the CSCA margins, historically, they've been in the 36%-37% range. This year, closer to 33%, perhaps a bit lower with some of the spend. How do we think about the normalized margins for that CSCA business over the next couple of years? Thanks.
Let me do the first part, then Ray will talk to you about margins. The structural cost that I was talking about has nothing to do with the investment. The transformational investments were $20 million, $25 million last year, and they're roughly $50 million this year, $30 million incremental. Those are investments that, if you look at it's 50% against innovation activities ramping up, 25% against momentum-enabling technologies, and 25% against e-commerce. That's kind of how we spend the 50%. The structural ones, you're talking about things like our D&O insurance up $15 million, affecting $0.08 of EPS. Exited businesses of roughly $15 million, somewhere around that area, around $0.09 a share, and some normal wage and merit increases. Those are just sort of incremental things that are part of the business that have a negative impact, if that makes sense. Those are two different thoughts.
Ray, you want to talk about margins?
Yeah. Our margins in the Americas business, are you talking gross margin or operating margin?
Yeah. No, gross margins. I'm just looking. They've come down several hundred basis points in recent years, and I'm just wanting to better understand where you think they're going over the next couple of years. Can they get back to where they were? Can you stabilize? What can you do to drive margins back up?
Yeah. If we looked at our gross margin, it's definitely hurt a little by the Ranir acquisition. That's probably not going to come back immediately. Overall, I think if we looked at, let's say our gross margins with Ranir, we're down about 60, 70, about almost 70 basis points, 2019 versus 2018. As Murray's talked about, the fact that we move our portfolio from national brand equivalent to national brand better and amid the structural changes we're making, I think we would hope to arrest that decline and hopefully reverse it as we go forward.
Thanks, Randall.
Our next question comes from David Risinger with Morgan Stanley.
Morning, David.
Good morning, Murray. Sorry, I am in transit here. I just need to flip my headset. Okay, sorry about that. Congrats on the turnaround progress.
Thank you.
Talking about gross margin expansion on
I'm sorry, I can't hear you.
I'm sorry, I can't hear you.
There is also, I think, greater investment.
Dave, we can't hear you. Operator, maybe we can move on to the next question. Dave, you can come back.
Sure. Our next question.
Thank you.
will come from Ami Fadia with Silicon Valley Bank.
Hi. Good morning. Thanks for taking my question. I have three questions. Firstly is, with regards to the ProAir, the generic ProAir market potential, can you talk about the opportunity there and the ability to penetrate some of the volumes of other albuterol products? Secondly, just with regards to coronavirus, are you seeing any impact on demand for some of your products? Do you think we could see some benefit on that front, unfortunately, as we see more and more of such events? Just thirdly, can you talk about what your expectation is for the evolution of operating margins for the CSCI business over the next two, three years? Thank you.
Okay. I'll do the first two, Ray, you do the third one. The ProAir, again, I don't mean to keep beating a conservative drum. ProAir, we found out about two days ago. I think last May when I talked about it, I thought it would be roughly $0.10 a quarter. Since then, there's been three authorized generics that have come to the market. I went pretty conservative in what we put in here because as we speak, we're out selling that product right now. In about two days, we'll know pricing, we'll know acceptance, and we'll know demand. I hope I've put it in a position that it represents any upside to the guidance we're giving, not downside. From what I hear, so far, so good. It was good to see the product on "The Today Show" yesterday.
I want to make sure I understand. There's different levels of demand. There's some kind of levels of demand that I worry about, and there's some that I don't. Far, not on a broad level, I worry if certain customers start building inventories because they're runs on shelves and things like that. We haven't seen a lot of it. We've seen a little. From a consumer standpoint, I think you're asking me is that potentially an increase in demand from, as people get the flu, do they buy more cough and cold treatments and things like that? We're not forecasting any significant change for that. I haven't seen any uplift for that. It's a hard question to answer. I know where you're coming from with it, but so far, I would say I haven't seen any big spikes or anything.
It was already a high illness season.
Right. On the margin on CSCI, certainly the gross margin is impacted by, We saw great strength in our U.K. store brand business in 2019, and also for half a year, the Ranir, which is also acquisition. The European portion is included in CSCI, and that's also store brand at a relatively lower margin. Although on an operating margin, some of that comes back because we don't spend advertising and promotion dollars on those products. There's also in the year, we have some of that $20 million or so that we spent, $25 million that we spent on investments, and that found its way into CSCI margin. Going forward, though, we're focused on a couple of key initiatives.
We're putting in centralized finance, which will help us reduce costs, especially on our administration costs in Europe, which are high at the moment because the Omega acquisition wasn't well integrated until recently. As we focus on that, we would expect to see that drive our operating income up in Europe.
Yeah
in the international.
Yeah, our plans call for margin expansion over the next few years.
They do.
in CSCI, and it's a good portion of the Project Momentum savings, as Ray just highlighted, are coming from there. You do have a negative mix impact, but that's not a bad thing. It's all incremental.
Totally incremental volume.
Yeah. You put in Ranir, and that was mostly a branded business with 50% gross margins. You put in $100 million of net sales in a growing U.K. store brand business. Again, that's entirely incremental to our product line.
Right.
It has some mix effect, but not any kind of cannibalistic mix effect. We expect margin expansion in CSCI.
Thanks. Next question, please.
Our next question will come from David Risinger with Morgan Stanley.
Welcome back.
Thanks very much. Thank you. Sorry about that earlier. I have two questions, Murray, please. First, Perrigo discussed incremental cost reduction opportunities on January 14th. Today you're talking about additional investment spending. Could you just juxtapose the two and help us better understand the net cost trend outlook? Second, with respect to operating cash flow, what we should expect in 2020 for operating cash flow relative to 2019. Thanks very much.
You have the third one?
Yeah.
The first two were kind of a combination question, but none of that's changed. We have a $100 million cost savings target on Project Momentum. If you look at the guidance we gave back in May, and despite a number of negative things that hit us, we raised guidance several times through the year and came in at a meaningfully higher number than we went out with in May. Project Momentum had a good portion of that, and I think that's the best example, right? We were investing along the way, but we're saving. You've ramped up here to what cumulatively is now around $50 million of investment, a good portion of that in R&D, but Those are designed to generate revenues and profits on their own right. I can't just take one against the other.
If they need to add sales, some of them are, if it takes me two years and it's new for us to develop and switch a product like Nasonex ourself, yeah, you got a couple of years before you get that benefit. You're talking about roughly $50 million of investment and $100 million of cost savings. I think we said roughly a little bit last year and then split like a third, a third, a third over the next few years. Some of them are longer-term, not because they just require things like the central finance that Ray talked about and the systems that go in place to help make that accomplished. There's equipment and manufacturing, et cetera. It's all part of that plan that feeds into the model of the 357, and it's on track.
Most investors that I talk to, David, over the course of the last year, they want to know I'm building a great company for the future that has sustainable growth, not doing quick fixes. That's exactly what we're doing. We have made major progress around here in our capabilities. You'll see those benefits over time start to have major paybacks. Just like I went through the example on M&A and the criteria for that, we do the same thing on these investments. The investments in e-commerce are already projecting to be a $100 million-$200 million business for us next year at only a year out. The investments in Nasonex should turn into a very big piece of business for us a couple of years from now. We put $500 million of new products into the pipeline.
I think that's now with some of the more recent things that have come up into the over $600 million of new products. You'll see that those all affect the overall margins, if that makes sense.
That's helpful. Thank you.
You want me to answer?
Yeah, the last one.
On the cash flow question, I think we were clear in the prepared remarks that we had some one-time negatives to our cash flow. Therefore, we would expect in 2020 that our cash flow conversion rate would exceed 100%, because we're seeing specifically those accounts receivable that went the wrong way in 2019 are going to come back to us in 2020. We don't expect to have to pay withholding taxes.
Great. Thank you.
Thank you. Last question, please.
Our last question will come from Elliot Wilbur with Raymond James.
Hey, thanks. Good morning. Not surprisingly, another line of questioning around margins. If you look at the reported number in the quarter, I think it's basically the lowest level we've seen from the company in six or seven years. I understand, obviously, there's a lot of investment and a lot of change taking place. You've talked about a growth framework comparable to consumer companies, is there anything you could offer up in terms of benchmark or bogey with respect to overall operating margins for the company as a whole? Obviously, we expect them to improve, at 16.2% in the quarter, I don't know if a good long-term target is 17.5%, 18%, or if you think you could actually drive that a little bit higher. Within the context of that question, I want to ask specifically about CSCI margins.
Obviously, much higher gross margin business, but operating margins still fall 400 to 500 basis points below the U.S. business. I'm just wondering if you think that that business could eventually evolve to a point where you have a comparable operating margin profile versus the U.S., or if the level of investment spend is simply too high and that's not likely to happen. Just last question, infant formula, strong quarter, benefited from a couple of one-time items, but you also have relatively easy comps now going forward. Just wondering if you think that business is back to the point now where we're going to see positive top-line comps going forward. Thanks.
Well, let me do the second part first. There weren't a couple of one-time items. Well, I guess if you look at a year ago, there was a couple of one-time items, right? You had a one-time, a little bit of extra contract pack inventory because we needed to get ready for making hypoallergenic. A year ago, you had a plant eruption in the fourth quarter. You're right on the couple of items. Bottom line, when you can adjust for all that, it was still a good, strong 10%-12% growth driven by new products that we expect to continue going forward. I think the comps should be good on nutrition. It's an area we haven't pushed as hard as I think we can push.
As much as I think it's good and it'll continue to grow and be a great contributor for us, I think there's a world of opportunity in the nutrition business, and we thought too small in the way we invest in that business. My comparison would be sort of oral health here, where Ranir, we've already added a couple acquisitions that'll grow that business 25% pretty quickly. I expect nutrition to be an important segment and one of the five pillars for us, or one of the five growth priorities for the company, and I think the comps should be good from this point going forward. As it relates to the second part, right?
I think as it relates to the operating margins, clearly, we've got a big focus on cost control as well as on growth. We are spending, as we've already talked about, an extra $50 million in cost next year to help to drive the business forward. We wouldn't expect that margin increase to come in 2020. Going forward, we talked to investors last year, $100 million in anticipated cost savings from the Project Momentum, which is completely focused on operating expenses. We've also got another part of that project where we're looking at cost of goods sold, which we're driving margins that way. It's definitely a focus for us, is to drive our margins up. We would anticipate that would be part of our 5% earnings growth target as we come into 2021.
Listen, depending on the timing of it, et cetera, but I talk about the 3-5-7 of consumer. That means on consumers, you got to get into the 18% range of operating margins over time, and that's what we'll be targeting. You want to bring your leverage down to below three turns, too. Those are all the targets that we're working against over time.
Right.
Thank you.
This concludes our question and answer session. I would like to turn the conference back over to Murray Kessler for any closing remarks.
Yeah. Let me just close that. I was optimistic when I joined the company. Time is flying by. It's not that long. We spent six months getting a strategy. We launched it in May. To see the kind of response from the businesses with real fundamentals changing and great execution and the energy level in this company, I don't know what the multiple is. It's exponential of how I feel about the future. I'm very excited about Perrigo. We're making the right decisions to make this a great company so we can sustain profitable growth over the long term. I'll always be conservative in nature. It's just who I am when I give guidance. As I'm sure, I don't like the erratic kind of forecasts that were before I got here.
We've had five quarters now of meeting or beating, and we look forward to doing the same going forward. Thank you for your interest in Perrigo.
The conference is now concluded. Thank you for attending today's presentation. You may now disconnect.