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Basis of Presentation and Summary of Significant Accounting Polices - Intangibles and Goodwill (Details)
$ in Thousands
12 Months Ended
Dec. 31, 2020
USD ($)
reporting_unit
Dec. 31, 2019
USD ($)
Dec. 31, 2018
USD ($)
Goodwill [Line Items]      
Exclusive license agreement amortization expense $ 11,100 $ 10,600 $ 11,700
Number of reporting units | reporting_unit 7    
Goodwill $ 759,102 752,592 $ 749,144
Minimum      
Goodwill [Line Items]      
Goodwill discount rate 8.80%    
Maximum      
Goodwill [Line Items]      
Goodwill discount rate 13.20%    
Canada      
Goodwill [Line Items]      
Goodwill impairment   $ 7,300  
Goodwill $ 106,300    
Percentage of fair value in excess of carrying amount 14.00%