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Consolidated Statements of Cash Flows - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2021
Sep. 30, 2020
Cash flows from operating activities    
Net loss $ (380,636) $ (363,806)
Adjustments to reconcile net loss to net cash used in operating activities:    
Depreciation and amortization 45,323 31,088
Non-cash operating lease expense 5,516 4,295
Non-cash finance lease amortization expense   41,382
Non-cash royalty revenue related to sale of future royalties (14,317) (299)
Non-cash interest expense on liability related to sale of future royalties 57,755 14,557
Change in valuation of deferred and contingent consideration 11,600 16,980
Settlement of deferred and contingent consideration   10,613
Non-cash stock consideration, acquisition   42,869
Unrealized (gain) loss on ClearPoint Equity Investments (2,376) (852)
Unrealized (gain) loss on ClearPoint convertible debt security (2,054) (633)
Unrealized gain on marketable securities - equity investments (1,350)  
Non-cash interest expense   16,678
Loss on disposal of asset   25
Amortization of premiums (discounts) on investments, net 4,052 (559)
Amortization of debt issuance costs 1,377 766
Share-based compensation expense 77,277 48,909
Unrealized foreign currency transaction losses (gains), net 33,280 (27,077)
Changes in operating assets and liabilities:    
Inventory, net 2,476 390
Prepaid expenses and other current assets 8,161 (9,289)
Trade receivables, net (28,625) 121
Deposits and other assets (444) (217)
Accounts payable and accrued expenses 8,888 54,390
Other liabilities (4,340) (4,096)
Deferred revenue (4,055) (5,940)
Net cash used in operating activities (182,492) (129,705)
Cash flows from investing activities    
Purchases of fixed assets (19,487) (11,491)
Purchase of convertible debt security   (10,000)
Purchases of marketable securities - available for sale (276,376) (1,006,946)
Purchases of marketable securities - equity investments (205,382)  
Sale and redemption of marketable securities- available for sale 693,319 700,627
Sale and redemption of marketable securities - equity investments 740  
Acquisition of product rights and licenses (41,806) (25,618)
Purchase of equity investment in ClearPoint (100)  
Net cash provided by (used in) investing activities 150,908 (353,428)
Cash flows from financing activities    
Proceeds from exercise of options 16,120 32,987
Termination and exit fees related to payoff of secured term loan   (597)
Net proceeds from public offerings   28,092
Repayment of senior secured term loan   (28,333)
Payments on deferred consideration obligation   (38,100)
Proceeds from employee stock purchase plan 2,627 2,406
Payment of finance lease principal (2,224) (17,829)
Cash consideration received from Royalty Purchase Agreement   650,000
Net cash provided by (used in) financing activities 16,523 628,626
Effect of exchange rate changes on cash (3,933) 449
Net decrease in cash and cash equivalents (18,994) 145,942
Cash and cash equivalents, and restricted cash beginning of period 216,312 295,528
Cash and cash equivalents, and restricted cash end of period 197,318 441,470
Supplemental disclosure of cash information    
Cash paid for interest 9,589 9,802
Cash paid for income taxes 5,527 1,562
Supplemental disclosure of non-cash investing and financing activity    
Unrealized gain (loss) on marketable securities, net of tax (1,505) 1,639
Right-of-use assets obtained in exchange for operating lease obligations   76,657
Right-of-use assets obtained in exchange for finance lease obligations   41,382
Acquisition of product rights and licenses $ 19,154 13,786
Issuance of common stock related to rights exchange   $ 150,528