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Income taxes - Narrative (Details) - USD ($)
$ in Thousands
12 Months Ended
Dec. 31, 2023
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2018
Operating loss carryforwards        
Taxable income before consideration of NOL $ 102,500      
State income tax benefit 27,226 $ (4,224) $ (3,844)  
Deferred tax valuation allowance 833,810 672,172    
Valuation allowance, deferred tax asset, increase (decrease) 161,600 146,600    
Deferred tax liability on indefinite-lived intangibles acquired $ 55,905 $ 102,834    
Federal income tax provision at statutory rate 21.00% 21.00% 21.00%  
Uncertain tax position $ 0      
Increase in current taxable income resulting from the elimination of current deduction of qualifying R&D costs under Section 174. 300,300      
Undistributed earnings from non-US subsidiaries 345,900      
Undistributed earnings from non-US subsidiaries, tax 0      
Unrecognized tax benefits 1,360 $ 27,217    
Agilis        
Operating loss carryforwards        
Deferred tax liability on indefinite-lived intangibles acquired       $ 122,000
Federal        
Operating loss carryforwards        
Net operating loss carryforwards 287,000      
Research and development credit carryforwards 35,900      
Research and development credit carryforwards expiring during the period 600      
Orphan Drug Credit carryover 169,600      
State        
Operating loss carryforwards        
Net operating loss carryforwards 208,800      
Foreign Tax Authority        
Operating loss carryforwards        
Net operating loss carryforwards $ 12,100