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Fourth Quarter Financial Data (Unaudited) (Details) - USD ($)
$ / shares in Units, shares in Thousands, $ in Thousands
 1 Months Ended 2 Months Ended 3 Months Ended 12 Months Ended
Oct. 31, 2020
Dec. 31, 2020
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2018
Fourth Quarter Financial Data (Unaudited) [Abstract]              
Revenue     $ 290,281 $ 493,680      
Operating expenses     312,945 233,028 $ 901,346 $ 756,716 $ 661,046
Income (loss) from operations     (22,664) 260,652 (172,082) 365,883 (61,372)
Net income (loss)     (341,426) 203,957 (486,766) 303,262 214,985
Net income (loss) attributable to Ionis Pharmaceuticals, Inc. common stockholders     $ (340,271) $ 184,415 $ (451,286) $ 294,146 $ 273,741
Basic net income (loss) per share (in dollars per share)     $ (2.44) [1],[2] $ 1.31 [1],[2] $ (3.23) $ 2.12 $ 2.09
Diluted net income (loss) per share (in dollars per share)     $ (2.44) [2],[3] $ 1.28 [2],[3] $ (3.23) $ 2.08 $ 2.07
Income (Numerator) [Abstract]              
Income (loss) available to Ionis common stockholders     $ (340,272) $ 183,795 $ (451,487) $ 296,563 $ 276,868
Net income available to Ionis common shareholders       $ 196,485   $ 296,563 $ 276,868
Shares (Denominator) [Abstract]              
Shares used in computing basic net income (loss) per share (in shares)     139,956 140,583 139,612 139,998 132,320
Effect of Diluted Securities [Abstract]              
Shares issuable related to our ESPP (in shares)       18   18 6
Shares used in computing diluted net income per share (in shares)       153,303 139,612 142,872 134,056
0.125 Percent Convertible Senior Notes [Member]              
Fourth Quarter Financial Data (Unaudited) [Abstract]              
Interest rate on convertible senior notes   0.125% 0.125% 0.125% 0.125% 0.125%  
Income (Numerator) [Abstract]              
Shares issuable related to our convertible notes       $ 644      
Effect of Diluted Securities [Abstract]              
Shares issuable related to our convertible notes       860      
1 Percent Convertible Senior Notes [Member]              
Fourth Quarter Financial Data (Unaudited) [Abstract]              
Interest rate on convertible senior notes   1.00% 1.00% 1.00% 1.00% 1.00%  
Income (Numerator) [Abstract]              
Shares issuable related to our convertible notes       $ 12,046      
Effect of Diluted Securities [Abstract]              
Shares issuable related to our convertible notes       9,527      
Stock Options [Member]              
Effect of Diluted Securities [Abstract]              
Shares issuable related to stock-based compensation (in shares)       1,467   2,090 1,216
Restricted Stock Awards [Member]              
Effect of Diluted Securities [Abstract]              
Shares issuable related to stock-based compensation (in shares)       848   766 514
Ionis [Member]              
Fourth Quarter Financial Data (Unaudited) [Abstract]              
Net income (loss) attributable to Ionis Pharmaceuticals, Inc. common stockholders     $ (250,682) $ 121,552 $ (253,725) $ 262,490 $ 440,806
Akcea [Member]              
Fourth Quarter Financial Data (Unaudited) [Abstract]              
Net income (loss) attributable to Ionis Pharmaceuticals, Inc. common stockholders $ (3,603) $ (85,987) $ (89,590) $ 62,243      
Basic net income (loss) per share (in dollars per share)     $ (0.05) $ 0.87      
Weighted average shares owned in Akcea (in shares)     77,095 71,342      
[1] As discussed in Note 1, Organization and Significant Accounting Policies, we compute basic net income (loss) per share by dividing the total net income (loss) attributable to our common stockholders by our weighted-average number of common shares outstanding during the period. Our basic net income (loss) per share calculation for each of the fourth quarters in 2020 and 2019 considered our net income (loss) for Ionis on a stand-alone basis plus our share of Akcea’s net loss for the period. To calculate the portion of Akcea’s net loss attributable to our ownership, we multiplied Akcea’s loss per share by the weighted average shares we owned in Akcea during the period. As a result of this calculation, our total net income (loss) available to Ionis common stockholders for the calculation of net income (loss) per share is different than net income (loss) attributable to Ionis Pharmaceuticals, Inc. common stockholders in the consolidated statements of operations.
[2] We compute net income (loss) per share independently for each quarter during the year.
[3] We had net income available to Ionis common stockholders for the fourth quarter of 2019. As a result, we computed diluted net income per share using the weighted-average number of common shares and dilutive common equivalent shares outstanding during the period