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Consolidated Statements of Cash Flows - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2020
Dec. 31, 2019
Dec. 31, 2018
Cash flows from operating activities      
Net loss $ (438,160) $ (251,576) $ (128,081)
Adjustments to reconcile net loss to net cash used in operating activities:      
Depreciation and amortization 43,490 32,180 26,087
Non-cash operating lease expense 6,084 3,709  
Non-cash finance lease amortization expense 41,382    
Non-cash royalty revenue related to sale of future royalties (2,055)    
Non-cash interest expense on liability related to sale of future royalties 31,817    
Change in valuation of deferred and contingent consideration 23,280 48,360 19,340
Settlement of deferred and contingent consideration 10,613    
Non-cash stock consideration, acquisition 42,869    
Unrealized gain on equity investment in ClearPoint (14,310) (2,194)  
Unrealized gain on ClearPoint convertible debt security (19,252)    
Amortization of discounts on investments, net 409 (1,922) (433)
Amortization of debt issuance costs 1,020 694 524
Share-based compensation expense 70,325 42,134 33,252
Non-cash interest expense 22,598 12,027 7,518
Disposal of asset 16 312 2
Deferred income taxes 5,872 8,829  
Unrealized foreign currency transaction (gains) losses, net (56,980) (11,619) (59)
Changes in operating assets and liabilities:      
Inventory, net 1,841 (3,456) (5,823)
Prepaid expenses and other current assets (12,621) (8,835) (1,609)
Trade receivables, net (10,483) 11,525 (29,589)
Deposits and other assets (662) (484) (1,093)
Accounts payable and accrued expenses 70,798 26,836 43,877
Other liabilities (3,930) (3,771) 1,932
Deferred revenue (8,032) (1,388) 6,514
Net cash used in operating activities (194,071) (98,639) (27,641)
Cash flows from investing activities      
Purchases of fixed assets (17,843) (13,757) (7,097)
Purchase of convertible debt security (10,000)    
Purchases of marketable securities (1,439,665) (494,068) (68,614)
Sale and redemption of marketable securities 944,094 156,270 90,423
Acquisition of product rights and licenses (38,134) (31,682) (8,433)
Purchase of equity investment   (4,000)  
Business acquisition, net of cash acquired     (48,892)
Net cash provided by (used in) investing activities (561,548) (387,237) (42,613)
Cash flows from financing activities      
Proceeds from issuance of convertible notes   279,267  
Proceeds from exercise of options 70,179 18,276 10,868
Termination and exit fees related to payoff of secured term loan (597)    
Net proceeds from public offerings 28,092 323,756 117,916
Repayment of senior secured term loan (28,333) (11,667)  
Payments on deferred consideration obligation (38,100)    
Proceeds from employee stock purchase plan 5,303 3,577 2,787
Payment of finance lease principal (17,829)    
Cash consideration received from Royalty Purchase Agreement 650,000    
Net cash provided by financing activities 668,715 613,209 131,571
Effect of exchange rate changes on cash 7,688 (1,303) (3,611)
Net decrease in cash and cash equivalents (79,216) 126,030 57,706
Cash and cash equivalents, and restricted cash beginning of period 295,528 169,498 111,792
Cash and cash equivalents, and restricted cash end of period 216,312 295,528 169,498
Supplemental disclosure of cash information      
Cash paid for interest 9,802 7,693 7,773
Cash paid for income taxes 26,397 2,109 1,583
Supplemental disclosure of non-cash investing and financing activity      
Unrealized gain on marketable securities, net of tax of $0, $165, and $2, respectively 1,145 724 9
Right-of-use assets obtained in exchange for operating lease obligations 76,811 17,389  
Right-of-use assets obtained in exchange for finance lease obligations 41,382    
Acquisition of product rights and licenses 14,191 $ 11,434 $ 5,981
Issuance of common stock related to rights exchange 150,528    
Capital expenditures unpaid at the end of period $ 1,060