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Consolidated Statements of Cash Flows - USD ($)
$ in Thousands
 6 Months Ended
Jun. 30, 2021
Jun. 30, 2020
Cash flows from operating activities    
Net loss $ (247,012) $ (294,114)
Adjustments to reconcile net loss to net cash used in operating activities:    
Depreciation and amortization 28,573 19,445
Non-cash operating lease expense 3,666 2,401
Non-cash finance lease amortization expense   41,212
Non-cash royalty revenue related to sale of future royalties (8,681)  
Non-cash interest expense on liability related to sale of future royalties 38,083  
Change in valuation of deferred and contingent consideration 800 8,580
Settlement of deferred and contingent consideration   10,613
Non-cash stock consideration, acquisition   42,869
Unrealized (gain) loss on ClearPoint Equity Investments (4,110) 1,600
Unrealized (gain) loss on ClearPoint convertible debt security (4,326) 749
Unrealized gain on marketable securities - equity investments (694)  
Non-cash interest expense   10,993
Loss on disposal of asset   26
Amortization of premiums (discounts) on investments, net 2,644 (635)
Amortization of debt issuance costs 911 510
Share-based compensation expense 51,406 32,130
Unrealized foreign currency transaction losses (gains), net 15,983 (3,248)
Changes in operating assets and liabilities:    
Inventory, net 1,906 943
Prepaid expenses and other current assets 15,649 (16,569)
Trade receivables, net (9,420) 1,860
Deposits and other assets (289) (175)
Accounts payable and accrued expenses (9,223) (7,497)
Other liabilities (3,083) (4,132)
Deferred revenue (4,085) (3,925)
Net cash used in operating activities (131,302) (156,364)
Cash flows from investing activities    
Purchases of fixed assets (13,643) (8,183)
Purchase of convertible debt security   (10,000)
Purchases of marketable securities - available for sale (192,931) (367,102)
Purchases of marketable securities - equity investments (200,000)  
Sale and redemption of marketable securities- available for sale 514,716 428,490
Acquisition of product rights and licenses (21,838) (2,422)
Purchase of equity investment in ClearPoint (100)  
Net cash provided by (used in) investing activities 86,204 40,783
Cash flows from financing activities    
Proceeds from exercise of options 13,144 25,045
Net proceeds from public offerings   18,950
Repayment of senior secured term loan   (10,000)
Payments on deferred consideration obligation   (35,829)
Proceeds from employee stock purchase plan 2,627 2,406
Payment of finance lease principal (2,224) (15,000)
Net cash provided by (used in) financing activities 13,547 (14,428)
Effect of exchange rate changes on cash 86 442
Net decrease in cash and cash equivalents (31,465) (129,567)
Cash and cash equivalents, and restricted cash beginning of period 216,312 295,528
Cash and cash equivalents, and restricted cash end of period 184,847 165,961
Supplemental disclosure of cash information    
Cash paid for interest 5,182 5,286
Cash paid for income taxes 4,127 1,140
Supplemental disclosure of non-cash investing and financing activity    
Unrealized gain (loss) on marketable securities, net of tax (1,369) 2,655
Right-of-use assets obtained in exchange for operating lease obligations 13 18,117
Right-of-use assets obtained in exchange for finance lease obligations   41,212
Acquisition of product rights and licenses $ 18,369 12,186
Issuance of common stock related to rights exchange   $ 150,528