Schedule of Effective Income Tax Rate Reconciliation (Details) - USD ($) $ in Thousands	12 Months Ended
	Dec. 31, 2019	Dec. 31, 2018	Dec. 31, 2017
Income Tax Disclosure [Abstract]
Federal statutory income tax benefit	$ (19,911)	$ (29,968)	$ (12,556)
State and local taxes	(2,784)	(276)	7,282
Orphan Drug & General Business Credit	43,124	66,451	33,683
Stock compensation expense	239	(5,647)	(6,843)
Changes in the fair value of contingent consideration	(1,804)	(2,361)	1,099
Foreign Source Income Subject to US Tax	(52)	6,543	30,181
Foreign tax rate differential (1)	(30,639)	12,583	9,403
Section 162(m) limitation	8,294	7,440	9,492
Tax Cuts and Jobs Act of 2017	0	0	42,338
Tax Reserves	12,123	8,545	2,262
Other	(1,132)	(423)	(2,940)
Valuation allowance/deferred benefit	7,827	4,521	35,132
Provision for (benefit from) income taxes	$ (70,963)	$ (65,494)	$ 81,167