﻿<?xml version="1.0" encoding="utf-8"?>
<InstanceReport xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:xsd="http://www.w3.org/2001/XMLSchema">
  <Version>2.2.0.7</Version>
  <hasSegments>false</hasSegments>
  <ReportName>Significant Accounting Policies</ReportName>
  <ReportLongName>0202 - Disclosure - Significant Accounting Policies</ReportLongName>
  <DisplayLabelColumn>true</DisplayLabelColumn>
  <ShowElementNames>false</ShowElementNames>
  <RoundingOption />
  <HasEmbeddedReports>false</HasEmbeddedReports>
  <Columns>
    <Column>
      <LabelColumn>false</LabelColumn>
      <Id>1</Id>
      <Labels>
        <Label Id="1" Label="9 Months Ended" />
        <Label Id="2" Label="Sep. 30, 2010" />
      </Labels>
      <CurrencyCode>USD</CurrencyCode>
      <FootnoteIndexer />
      <hasSegments>false</hasSegments>
      <hasScenarios>false</hasScenarios>
      <Segments />
      <Scenarios />
      <Units>
        <Unit>
          <UnitID>USD</UnitID>
          <UnitType>Standard</UnitType>
          <StandardMeasure>
            <MeasureSchema>http://www.xbrl.org/2003/iso4217</MeasureSchema>
            <MeasureValue>USD</MeasureValue>
            <MeasureNamespace>iso4217</MeasureNamespace>
          </StandardMeasure>
          <Scale>0</Scale>
        </Unit>
        <Unit>
          <UnitID>USDEPS</UnitID>
          <UnitType>Divide</UnitType>
          <NumeratorMeasure>
            <MeasureSchema>http://www.xbrl.org/2003/iso4217</MeasureSchema>
            <MeasureValue>USD</MeasureValue>
            <MeasureNamespace>iso4217</MeasureNamespace>
          </NumeratorMeasure>
          <DenominatorMeasure>
            <MeasureSchema>http://www.xbrl.org/2003/instance</MeasureSchema>
            <MeasureValue>shares</MeasureValue>
            <MeasureNamespace>xbrli</MeasureNamespace>
          </DenominatorMeasure>
          <Scale>0</Scale>
        </Unit>
        <Unit>
          <UnitID>Shares</UnitID>
          <UnitType>Standard</UnitType>
          <StandardMeasure>
            <MeasureSchema>http://www.xbrl.org/2003/instance</MeasureSchema>
            <MeasureValue>shares</MeasureValue>
            <MeasureNamespace>xbrli</MeasureNamespace>
          </StandardMeasure>
          <Scale>0</Scale>
        </Unit>
      </Units>
      <CurrencySymbol>$</CurrencySymbol>
    </Column>
  </Columns>
  <Rows>
    <Row>
      <Id>2</Id>
      <Label>Significant Accounting Policies [Abstract]</Label>
      <Level>0</Level>
      <ElementName>mdco_SignificantAccountingPoliciesAbstract</ElementName>
      <ElementPrefix>mdco</ElementPrefix>
      <IsBaseElement>false</IsBaseElement>
      <BalanceType>na</BalanceType>
      <PeriodType>duration</PeriodType>
      <ShortDefinition>Significant Accounting Policies.</ShortDefinition>
      <IsReportTitle>false</IsReportTitle>
      <IsSegmentTitle>false</IsSegmentTitle>
      <IsSubReportEnd>false</IsSubReportEnd>
      <IsCalendarTitle>false</IsCalendarTitle>
      <IsTuple>false</IsTuple>
      <IsAbstractGroupTitle>true</IsAbstractGroupTitle>
      <IsEquityPrevioslyReportedAsRow>false</IsEquityPrevioslyReportedAsRow>
      <IsEquityAdjustmentRow>false</IsEquityAdjustmentRow>
      <IsBeginningBalance>false</IsBeginningBalance>
      <IsEndingBalance>false</IsEndingBalance>
      <IsReverseSign>false</IsReverseSign>
      <PreferredLabelRole />
      <IsEPS>false</IsEPS>
      <FootnoteIndexer />
      <Cells>
        <Cell>
          <Id>1</Id>
          <ShowCurrencySymbol>false</ShowCurrencySymbol>
          <IsNumeric>false</IsNumeric>
          <IsRatio>false</IsRatio>
          <DisplayZeroAsNone>false</DisplayZeroAsNone>
          <NumericAmount>0</NumericAmount>
          <RoundedNumericAmount>0</RoundedNumericAmount>
          <NonNumbericText />
          <NonNumericTextHeader />
          <FootnoteIndexer />
          <hasSegments>false</hasSegments>
          <hasScenarios>false</hasScenarios>
          <DisplayDateInUSFormat>false</DisplayDateInUSFormat>
        </Cell>
      </Cells>
      <OriginalInstanceReportColumns />
      <ElementDataType>xbrli:stringItemType</ElementDataType>
      <SimpleDataType>string</SimpleDataType>
      <ElementDefenition>Significant Accounting Policies.</ElementDefenition>
      <IsTotalLabel>false</IsTotalLabel>
    </Row>
    <Row>
      <Id>3</Id>
      <Label>Significant Accounting Policies</Label>
      <Level>1</Level>
      <ElementName>us-gaap_SignificantAccountingPoliciesTextBlock</ElementName>
      <ElementPrefix>us-gaap</ElementPrefix>
      <IsBaseElement>true</IsBaseElement>
      <BalanceType>na</BalanceType>
      <PeriodType>duration</PeriodType>
      <ShortDefinition>No definition available.</ShortDefinition>
      <IsReportTitle>false</IsReportTitle>
      <IsSegmentTitle>false</IsSegmentTitle>
      <IsSubReportEnd>false</IsSubReportEnd>
      <IsCalendarTitle>false</IsCalendarTitle>
      <IsTuple>false</IsTuple>
      <IsAbstractGroupTitle>false</IsAbstractGroupTitle>
      <IsEquityPrevioslyReportedAsRow>false</IsEquityPrevioslyReportedAsRow>
      <IsEquityAdjustmentRow>false</IsEquityAdjustmentRow>
      <IsBeginningBalance>false</IsBeginningBalance>
      <IsEndingBalance>false</IsEndingBalance>
      <IsReverseSign>false</IsReverseSign>
      <PreferredLabelRole>verboselabel</PreferredLabelRole>
      <IsEPS>false</IsEPS>
      <FootnoteIndexer />
      <Cells>
        <Cell>
          <Id>1</Id>
          <ShowCurrencySymbol>false</ShowCurrencySymbol>
          <IsNumeric>false</IsNumeric>
          <IsRatio>false</IsRatio>
          <DisplayZeroAsNone>false</DisplayZeroAsNone>
          <NumericAmount>0</NumericAmount>
          <RoundedNumericAmount>0</RoundedNumericAmount>
          <NonNumbericText>&lt;!--DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd" --&gt;
   &lt;!-- Begin Block Tagged Note 2 - us-gaap:SignificantAccountingPoliciesTextBlock--&gt;
   &lt;div align="left" style="font-family: 'Times New Roman',Times,serif"&gt;
   &lt;div align="left" style="font-size: 10pt; margin-top: 12pt"&gt;&lt;b&gt;2. Significant Accounting Policies&lt;/b&gt;
   &lt;/div&gt;
   &lt;div align="left" style="font-size: 10pt; margin-top: 6pt"&gt;&amp;#160;&amp;#160;&amp;#160;&amp;#160;&amp;#160;The Company&amp;#8217;s significant accounting policies are described in note 2 of the notes to the
   consolidated financial statements included in the Annual Report on Form 10-K for the year ended
   December&amp;#160;31, 2009 filed with the Securities and Exchange Commission (SEC).
   &lt;/div&gt;
   &lt;div align="left" style="font-size: 10pt; margin-top: 6pt"&gt;&amp;#160;&amp;#160;&amp;#160;&amp;#160;&amp;#160;&lt;b&gt;&lt;i&gt;Basis of Presentation&lt;/i&gt;&lt;/b&gt;
   &lt;/div&gt;
   &lt;div align="left" style="font-size: 10pt; margin-top: 6pt"&gt;&amp;#160;&amp;#160;&amp;#160;&amp;#160;&amp;#160;The accompanying condensed consolidated financial statements have been prepared in accordance
   with U.S. generally accepted accounting principles (GAAP)&amp;#160;for interim financial information and
   with the instructions to Form 10-Q. Accordingly, they do not include all the information and
   footnotes required by GAAP for complete financial statements. In the opinion of management, the
   accompanying financial statements include all adjustments, consisting of normal recurring accruals,
   considered necessary for a fair presentation of the Company&amp;#8217;s financial position, results of
   operations, and cash flows for the periods presented.
   &lt;/div&gt;
   &lt;div align="left" style="font-size: 10pt; margin-top: 6pt"&gt;&amp;#160;&amp;#160;&amp;#160;&amp;#160;&amp;#160;The condensed consolidated financial statements include the accounts of the Company and its
   wholly-owned subsidiaries. All intercompany balances and transactions have been eliminated in
   consolidation. The Company has no unconsolidated subsidiaries or investments accounted for under
   the equity method.
   &lt;/div&gt;
   &lt;div align="left" style="font-size: 10pt; margin-top: 6pt"&gt;&amp;#160;&amp;#160;&amp;#160;&amp;#160;&amp;#160;The results of operations for the three months and nine months ended September&amp;#160;30, 2010 are
   not necessarily indicative of the results that may be expected for the entire fiscal year or the
   fourth quarter of the fiscal year ending December&amp;#160;31, 2010. These condensed consolidated financial
   statements should be read in conjunction with the audited financial statements included in the
   Company&amp;#8217;s Annual Report on Form 10-K for the year ended December&amp;#160;31, 2009, filed with the SEC.
   &lt;/div&gt;
   &lt;div align="left" style="font-size: 10pt; margin-top: 6pt"&gt;&amp;#160;&amp;#160;&amp;#160;&amp;#160;&amp;#160;&lt;b&gt;&lt;i&gt;Use of Estimates&lt;/i&gt;&lt;/b&gt;
   &lt;/div&gt;
   &lt;div align="left" style="font-size: 10pt; margin-top: 6pt"&gt;&amp;#160;&amp;#160;&amp;#160;&amp;#160;&amp;#160;The preparation of financial statements in conformity with GAAP requires management to make
   estimates and assumptions that affect the reported amounts of assets, liabilities, revenue, costs,
   expenses and accumulated other comprehensive income/(loss) that are reported in the consolidated
   financial statements and accompanying disclosures. Actual results may be different. See note 2 of
   the
   notes to the consolidated financial statements in the Company&amp;#8217;s Annual Report on Form 10-K for the
   year ended December&amp;#160;31, 2009 for a discussion of the Company&amp;#8217;s critical accounting estimates.
   &lt;/div&gt;
   &lt;div align="left" style="font-size: 10pt; margin-top: 6pt"&gt;&amp;#160;&amp;#160;&amp;#160;&amp;#160;&amp;#160;&lt;b&gt;&lt;i&gt;Reclassifications&lt;/i&gt;&lt;/b&gt;
   &lt;/div&gt;
   &lt;div align="left" style="font-size: 10pt; margin-top: 6pt"&gt;&amp;#160;&amp;#160;&amp;#160;&amp;#160;&amp;#160;Certain prior year amounts have been reclassified to conform to the current year presentation.
   &lt;/div&gt;
   &lt;div align="left" style="font-size: 10pt; margin-top: 6pt"&gt;&amp;#160;&amp;#160;&amp;#160;&amp;#160;&amp;#160;&lt;b&gt;&lt;i&gt;Recent Accounting Pronouncements&lt;/i&gt;&lt;/b&gt;
   &lt;/div&gt;
   &lt;div align="left" style="font-size: 10pt; margin-top: 6pt"&gt;&amp;#160;&amp;#160;&amp;#160;&amp;#160;&amp;#160;In June&amp;#160;2009, the FASB issued SFAS No.&amp;#160;167, &amp;#8220;Amendments to FASB Interpretation No.&amp;#160;46(R)&amp;#8221;,
   which was later superseded by the FASB Codification and included in ASC topic 810-10 (ASC 810-10),
   which modifies how a company determines when an entity that is insufficiently capitalized or is not
   controlled through voting (or similar rights) should be consolidated. ASC 810-10 clarifies that the
   determination of whether a company is required to consolidate an entity is based on, among other
   things, an entity&amp;#8217;s purpose and design and a company&amp;#8217;s ability to direct the activities of the
   entity that most significantly impact the entity&amp;#8217;s economic performance. ASC 810-10 requires an
   ongoing reassessment of whether a company is the primary beneficiary of a variable interest entity.
   ASC 810-10 also requires additional disclosures about a company&amp;#8217;s involvement in variable interest
   entities and any significant changes in risk exposure due to that involvement. This guidance is
   effective for fiscal years beginning after November&amp;#160;15, 2009 and was effective for the Company on
   January&amp;#160;1, 2010. The Company adopted this accounting pronouncement as of January&amp;#160;1, 2010 and it did
   not have a material impact on its consolidated financial statements.
   &lt;/div&gt;
   &lt;/div&gt;
</NonNumbericText>
          <NonNumericTextHeader>&lt;!--DOCTYPE html PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/xhtml1/DTD/xhtml1-transitional.dtd" --&gt;
   &lt;!-- Begin Block Tagged Note</NonNumericTextHeader>
          <FootnoteIndexer />
          <hasSegments>false</hasSegments>
          <hasScenarios>false</hasScenarios>
          <DisplayDateInUSFormat>false</DisplayDateInUSFormat>
        </Cell>
      </Cells>
      <OriginalInstanceReportColumns />
      <ElementDataType>us-types:textBlockItemType</ElementDataType>
      <SimpleDataType>textblock</SimpleDataType>
      <ElementDefenition>This element may be used to describe all significant accounting policies of the reporting entity.</ElementDefenition>
      <ElementReferences>Reference 1: http://www.xbrl.org/2003/role/presentationRef
 -Publisher AICPA
 -Name Accounting Principles Board Opinion (APB)
 -Number 22
 -Paragraph 8

</ElementReferences>
      <IsTotalLabel>false</IsTotalLabel>
    </Row>
  </Rows>
  <Footnotes />
  <NumberOfCols>1</NumberOfCols>
  <NumberOfRows>2</NumberOfRows>
  <HasScenarios>false</HasScenarios>
  <MonetaryRoundingLevel>UnKnown</MonetaryRoundingLevel>
  <SharesRoundingLevel>UnKnown</SharesRoundingLevel>
  <PerShareRoundingLevel>UnKnown</PerShareRoundingLevel>
  <HasPureData>false</HasPureData>
  <SharesShouldBeRounded>true</SharesShouldBeRounded>
</InstanceReport>
