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Taxation - Narrative (Details) - USD ($)
$ in Thousands
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Taxation [Line Items]      
Percentage vote and value of subsidiaries included in the Group consolidated federal tax return 80.00% 80.00% 80.00%
Percentage vote and value of subsidiaries in the Group consolidated state tax return 50.00% 50.00% 50.00%
Income tax expense/(benefit) $ (55,719) $ 3,756 $ 14,401
Total deferred income tax expense/(benefit) (70,120) (18,491) (7,395)
Total current income tax expense/(benefit) 14,401 22,247 21,796
UNITED STATES      
Taxation [Line Items]      
Deferred tax assets (liabilities), net, not recognized 92,962 72,843  
Federal      
Taxation [Line Items]      
Total deferred income tax expense/(benefit) (48,240) (15,416) (7,349)
Total current income tax expense/(benefit) 13,065 22,138 21,796
Tax Losses 219,500 215,400 169,700
Tax Credits 4,500 3,900 3,900
Unused federal orphan drug tax credits 6,100 5,700  
Federal | Operating loss carryforwards not subject to expiration      
Taxation [Line Items]      
Tax Losses 152,700    
MASSACHUSETTS      
Taxation [Line Items]      
Tax Losses 71,700 27,900 67,400
Tax Credits $ 600 $ 1,300 $ 2,100