Contingencies and commitments (Details) $ in Thousands			1 Months Ended	2 Months Ended	3 Months Ended
	Apr. 25, 2019 USD ($)	Apr. 04, 2019 agreement	Apr. 19, 2019 complaints lawsuit	Apr. 10, 2019 actions plaintiffs lawsuit	Mar. 31, 2019 patent
Subsequent Event [Member] | Settlement Agreement with U.S. Department of Justice and Office of Inspector General [Member]
Loss Contingencies [Line Items]
Loss contingency, amount agreed to be paid | $	$ 24,750
Corporate Integrity Agreement with OIG, term	5 years
Sensipar Antitrust Class Actions [Member] | Subsequent Event [Member]
Loss Contingencies [Line Items]
Number of plaintiffs | plaintiffs				4
Number of actions brought in Delaware District Court | actions				2
Number of lawsuits | lawsuit				4
MVASI Patent Litigation [Member]
Loss Contingencies [Line Items]
Loss contingency, number of patents allegedly infringed | patent					14
MVASI Patent Litigation [Member] | Seeking Injunctive Relief [Member]
Loss Contingencies [Line Items]
Loss contingency, number of patents allegedly infringed | patent					2
Humira Biosimilar Antitrust Class Actions [Member] | Subsequent Event [Member]
Loss Contingencies [Line Items]
Number of lawsuits | lawsuit			10
Number of complaints stayed by the court | complaints			6
Novartis Breach of Contract Action [Member] | Subsequent Event [Member]
Loss Contingencies [Line Items]
Number of collaboration agreements breached | agreement		2