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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands | 3 Months Ended | 12 Months Ended | 142 Months Ended
--- | --- | --- | ---
Mar. 31, 2023 | Dec. 31, 2023 | Dec. 31, 2022 | Dec. 31, 2021 | Dec. 31, 2023
Cash flows from operating activities: |  |  |  |  |
Net loss |  | $ (276,056) | $ (368,198) | $ (523,837) |
Adjustments to reconcile net loss to net cash used in operating activities: |  |  |  |  |
Non-cash royalty revenue related to the sales of future royalties |  | (68,921) | (69,794) | (77,746) | $ (472,166)
Non-cash interest expense on liabilities related to sales of future royalties |  | 25,334 | 28,911 | 47,313 | 298,518
Loss on revaluation of liability related to the sale of future royalties |  | 0 | 0 | 24,410 |
Change in fair value of development derivative liability |  | 0 | (33,427) | 8,023 |
Non-cash research and development expense |  | 0 | 4,951 | 16,703 |
Stock-based compensation |  | 33,388 | 57,320 | 94,674 |
Depreciation and amortization |  | 7,815 | 13,030 | 14,146 |
Deferred income tax expense |  | (140) | 2,708 | (102) |
Impairment of right-of-use assets and property, plant and equipment |  | 35,328 | 65,761 | 0 |
Impairment of goodwill | $ 76,500 | 76,501 | 0 | 0 |
(Gain) loss on sale or disposal of property, plant and equipment, net |  | 1,300 | (3,326) | 0 |
Provision for inventory obsolescence |  | 2,402 | 0 | 0 |
Foreign currency translation adjustment |  | 5,099 | 0 | 0 |
Amortization of premiums (discounts), net and other non-cash transactions |  | (14,856) | (2,435) | 6,730 |
Changes in operating assets and liabilities: |  |  |  |  |
Accounts receivable |  | 4,776 | 16,511 | 12,397 |
Inventory |  | 699 | (3,401) | (509) |
Operating leases, net |  | (8,850) | (2,680) | 2,340 |
Other assets |  | 3,583 | 6,906 | (2,586) |
Accounts payable |  | (2,884) | 3,103 | (11,690) |
Accrued expenses |  | (17,124) | (19,947) | (22,926) |
Net cash used in operating activities |  | (192,606) | (304,007) | (412,660) |
Cash flows from investing activities: |  |  |  |  |
Purchases of investments |  | (511,699) | (467,914) | (960,689) |
Maturities of investments |  | 650,883 | 826,229 | 1,166,951 |
Sales of investments |  | 0 | 0 | 11,504 |
Purchases of property, plant and equipment |  | (865) | (5,676) | (14,989) |
Sales of property, plant and equipment |  | 1,245 | 13,196 | 0 |
Net cash provided by investing activities |  | 139,564 | 365,835 | 202,777 |
Cash flows from financing activities: |  |  |  |  |
Cash receipts from development derivative liability |  | 0 | 750 | 3,000 |
Proceeds from shares issued under equity compensation plans |  | 30 | 758 | 33,238 |
Net cash provided by financing activities |  | 30 | 1,508 | 36,238 |
Effect of foreign exchange rates on cash and cash equivalents |  | 62 | (327) | (92) |
Net increase (decrease) in cash and cash equivalents |  | (52,950) | 63,009 | (173,737) |
Cash and cash equivalents at beginning of year | $ 88,227 | 88,227 | 25,218 | 198,955 |
Cash and cash equivalents at end of year |  | 35,277 | 88,227 | 25,218 | $ 35,277
Supplemental disclosure of cash flow information: |  |  |  |  |
Operating lease right-of-use assets recognized in exchange for lease liabilities |  | 0 | 0 | 1,057 |
Cash paid for income taxes |  | $ 2,656 | $ 272 | $ 325 |

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