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Consolidated Statements of Cash Flows (unaudited) - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2019
Sep. 30, 2018
Cash flows from operating activities    
Net loss $ (173,899) $ (79,751)
Adjustments to reconcile net loss to net cash used in operating activities:    
Depreciation and amortization 22,903 19,316
Change in valuation of warrant liability 0 3
Change in valuation of deferred and contingent consideration 35,960 0
Unrealized gain on MRI investment (2,529) 0
Non-cash interest expense 6,583 5,563
Loss on disposal of asset 0 2
Amortization of discounts on investments, net (1,374) (354)
Amortization of debt issuance costs 434 390
Share-based compensation expense 30,668 24,773
Unrealized foreign currency transaction losses (gains), net 205 (977)
Changes in operating assets and liabilities:    
Inventory (1,574) (3,252)
Prepaid expenses and other current assets (11,771) (1,301)
Trade receivables, net 5,879 (2,681)
Deposits and other assets (14,747) (385)
Accounts payable and accrued expenses 695 18,606
Other liabilities 12,553 1,617
Deferred revenue 1,581 5,933
Net cash used in operating activities (88,433) (12,498)
Cash flows from investing activities    
Purchases of fixed assets (9,104) (2,489)
Purchases of equity investment in MRI (4,000) 0
Purchases of marketable securities (239,386) (28,656)
Sale and redemption of marketable securities 114,500 65,923
Acquisition of product rights and licenses (20,250) (3,903)
Business acquisition, net of cash acquired 0 (48,892)
Net cash used in investing activities (158,240) (18,017)
Cash flows from financing activities    
Proceeds from exercise of options 12,195 8,631
Net proceeds from public offerings 324,262 117,915
Proceeds from Convertible Debt 279,571 0
Proceeds from shares issued under employee stock purchase plan 1,564 1,299
Repayments of Secured Debt (6,667) 0
Net cash provided by financing activities 610,925 127,845
Effect of exchange rate changes on cash (2,673) (2,209)
Net increase in cash and cash equivalents 361,579 95,121
Cash and cash equivalents, and restricted cash beginning of period 169,498 111,792
Cash and cash equivalents, and restricted cash end of period 523,577  
Supplemental disclosure of cash information    
Cash paid for interest 7,042 6,927
Cash paid for income taxes 1,931 919
Supplemental disclosure of non-cash investing and financing activity    
Unrealized (loss) gain on marketable securities 435 (50)
Right-of-use assets obtained in exchange for lease obligations 16,120 0
Acquisition of product rights and licenses 7,432 4,530
Accrued transaction costs related to public offerings 506 0
Accrued transaction costs related to issuance of convertible notes $ 298 $ 0