OPKO Health (OPK) 10-Q7 Nov 242024 Q3 Quarterly reportFinancial data

Company Profile

Document And Entity Information

Document And Entity Information - shares	9 Months Ended
Document And Entity Information - shares	Sep. 30, 2024	Nov. 01, 2024
Document Information [Line Items]
Entity Central Index Key	0000944809
Entity Registrant Name	OPKO HEALTH, INC.
Amendment Flag	false
Current Fiscal Year End Date	--12-31
Document Fiscal Period Focus	Q3
Document Fiscal Year Focus	2024
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2024
Document Transition Report	false
Entity File Number	001-33528
Entity Incorporation, State or Country Code	DE
Entity Tax Identification Number	75-2402409
Entity Address, Address Line One	4400 Biscayne Blvd.
Entity Address, City or Town	Miami
Entity Address, State or Province	FL
Entity Address, Postal Zip Code	33137
City Area Code	305
Local Phone Number	575-4100
Title of 12(b) Security	Common Stock, par value $0.01 per share
Trading Symbol	OPK
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		682,483,029

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets (Current Period Unaudited) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Current assets:
Cash, cash equivalents and current restricted cash	$ 406,400	$ 95,881
Accounts receivable, net	106,579	123,379
Inventory, net	59,408	65,697
Other current assets and prepaid expenses	57,249	24,519
Total current assets	629,636	309,476
Property, plant and equipment, net	72,271	75,429
Intangible assets, net	641,396	740,283
In-process research and development	195,000	195,000
Goodwill	535,868	598,260
Investments	100,609	16,082
Operating lease right-of-use assets	62,812	68,088
Other assets	18,511	9,080
Total assets	2,256,103	2,011,698
Current liabilities:
Accounts payable	62,721	69,677
Accrued expenses	122,806	90,086
Current maturities of operating leases	12,741	12,996
Current portion of convertible notes	170	0
Current portion of lines of credit and notes payable	13,222	27,293
Total current liabilities	211,660	200,052
Operating lease liabilities	52,057	54,140
Long term portion of convertible notes	178,695	214,325
Senior secured notes	245,358	0
Deferred tax liabilities	128,412	126,773
Other long-term liabilities, principally contract liabilities, contingent consideration and lines of credit	36,504	27,189
Total long-term liabilities	641,026	422,427
Total liabilities	852,686	622,479
Equity:
Common Stock - $0.01 par value, 1,250,000,000 shares authorized; 712,283,206 and 781,936,885 shares issued at September 30, 2024 and December 31, 2023, respectively	7,124	7,820
Treasury Stock - 29,800,177, and 8,655,082 shares at September 30, 2024 and December 31, 2023, respectively	(1,791)	(1,791)
Additional paid-in capital	3,516,735	3,433,006
Accumulated other comprehensive loss	(39,614)	(38,030)
Accumulated deficit	(2,079,037)	(2,011,786)
Total shareholders’ equity	1,403,417	1,389,219
Total liabilities and equity	$ 2,256,103	$ 2,011,698

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Current Period Unaudited) (Parentheticals) - $ / shares	Sep. 30, 2024	Dec. 31, 2023
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, authorized (in shares)	1,250,000,000	1,250,000,000
Common stock, issued (in shares)	712,283,206	781,936,885
Treasury Stock, Common, Shares (in shares)	29,800,177	8,655,082

Condensed Consolidated Statemen

Condensed Consolidated Statements of Operations (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Revenues:
Revenues	$ 173,632	$ 178,595	$ 529,504	$ 681,591
Costs and expenses:
Selling, general and administrative	98,203	72,240	237,191	227,676
Research and development	28,770	19,435	74,789	70,199
Contingent consideration	0	(1,125)	0	(1,023)
Amortization of intangible assets	20,433	21,534	62,290	64,543
Gain on sale of assets	(121,493)	0	(121,493)	0
Total costs and expenses	159,416	243,002	648,430	769,566
Operating income (loss)	14,216	(64,407)	(118,926)	(87,975)
Other income and (expense), net:
Interest income	2,928	970	4,132	3,077
Interest expense	(17,359)	(3,384)	(33,225)	(10,053)
Fair value changes of derivative instruments, net	(1)	88	(26,161)	(829)
Other income (expense), net	48,636	(11,645)	128,834	(16,045)
Other income (expense), net	34,204	(13,971)	73,580	(23,850)
Income (loss) before income taxes and investment losses	48,420	(78,378)	(45,346)	(111,825)
Income tax provision	(23,527)	(6,075)	(21,898)	(10,456)
Net income (loss) before investment losses	24,893	(84,453)	(67,244)	(122,281)
Loss from investments in investees	(3)	(20)	(7)	(99)
Net income (loss)	$ 24,890	$ (84,473)	$ (67,251)	$ (122,380)
Income (loss) per share:
Income (loss) per share, basic (in dollars per share)	$ 0.04	$ (0.11)	$ (0.1)	$ (0.16)
Income (loss) per share, diluted (in dollars per share)	$ 0.03	$ (0.11)	$ (0.1)	$ (0.16)
Weighted average common shares outstanding, basic (in shares)	694,622,466	751,525,007	699,675,944	751,716,692
Weighted average common shares outstanding, diluted (in shares)	998,363,636	751,525,007	699,675,944	751,716,692
Service [Member]
Revenues:
Revenues	$ 121,271	$ 131,679	$ 377,557	$ 391,100
Costs and expenses:
Cost of Goods and Services Sold	108,847	106,375	325,798	333,460
Product [Member]
Revenues:
Revenues	39,143	40,670	117,675	124,553
Costs and expenses:
Cost of Goods and Services Sold	24,656	24,543	69,855	74,711
Transfer of Intellectual Property and Other [Member]
Revenues:
Revenues	$ 13,218	$ 6,246	$ 34,272	$ 165,938

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Comprehensive Loss (Unaudited) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Net loss	$ 24,890	$ (84,473)	$ (67,251)	$ (122,380)
Other comprehensive income (loss), net of tax:
Change in foreign currency translation and other comprehensive income (loss)	7,038	(9,554)	(1,585)	(3,173)
Comprehensive income (loss)	$ 31,928	$ (94,027)	$ (68,836)	$ (125,553)

Consolidated Statements of Equi

Consolidated Statements of Equity (Unaudited) - USD ($) $ in Thousands	The 2025 Convertible Notes [Member] Common Stock [Member]	The 2025 Convertible Notes [Member] Treasury Stock, Common [Member]	The 2025 Convertible Notes [Member] Additional Paid-in Capital [Member]	The 2025 Convertible Notes [Member] AOCI Attributable to Parent [Member]	The 2025 Convertible Notes [Member] Retained Earnings [Member]	The 2025 Convertible Notes [Member]	The 2029 Convertible Notes 1 [Member] Common Stock [Member]	The 2029 Convertible Notes 1 [Member] Treasury Stock, Common [Member]	The 2029 Convertible Notes 1 [Member] Additional Paid-in Capital [Member]	The 2029 Convertible Notes 1 [Member] AOCI Attributable to Parent [Member]	The 2029 Convertible Notes 1 [Member] Retained Earnings [Member]	The 2029 Convertible Notes 1 [Member]	Common Stock [Member]	Treasury Stock, Common [Member]	Additional Paid-in Capital [Member]	AOCI Attributable to Parent [Member]	Retained Earnings [Member]	Total
Balance (in shares) at Dec. 31, 2022													781,306,164	(8,655,082)
Balance at December 31, 2023 at Dec. 31, 2022													$ 7,813	$ (1,791)	$ 3,421,872	$ (43,323)	$ (1,822,923)	$ 1,561,648
Equity-based compensation expense													0	0	8,745	0	0	8,745
Net loss													0	0	0	0	(122,380)	(122,380)
Other comprehensive loss													$ 0	$ 0	0	(3,172)	0	$ (3,172)
Exercise of common stock options and warrants (in shares)													405,721	0				18,750
Exercise of common stock options and warrants													$ 4	$ 0	(277)	0	0	$ (273)
Balance (in shares) at Sep. 30, 2023													781,711,885	(8,655,082)
Balance at September 30, 2024 at Sep. 30, 2023													$ 7,817	$ (1,791)	3,430,340	(46,495)	(1,945,303)	1,444,568
Balance (in shares) at Jun. 30, 2023													781,693,135	(8,655,082)
Balance at December 31, 2023 at Jun. 30, 2023													$ 7,817	$ (1,791)	3,427,094	(36,942)	(1,860,830)	1,535,348
Equity-based compensation expense													0	0	3,218	0	0	3,218
Net loss													0	0	0	0	(84,473)	(84,473)
Other comprehensive loss													$ 0	$ 0	0	(9,553)	0	$ (9,553)
Exercise of common stock options and warrants (in shares)													18,750	0				18,750
Exercise of common stock options and warrants													$ 0	$ 0	28	0	0	$ 28
Balance (in shares) at Sep. 30, 2023													781,711,885	(8,655,082)
Balance at September 30, 2024 at Sep. 30, 2023													$ 7,817	$ (1,791)	3,430,340	(46,495)	(1,945,303)	1,444,568
Balance (in shares) at Dec. 31, 2023													781,936,885	(8,655,082)
Balance at December 31, 2023 at Dec. 31, 2023													$ 7,820	$ (1,791)	3,433,006	(38,030)	(2,011,786)	1,389,219
Equity-based compensation expense													0	0	7,983	0	0	7,983
Repurchase of 2029 Convertible Notes													$ 0	0	(2,853)	0	0	(2,853)
Share repurchase (in shares)													(70,038,057)
Share repurchase													$ (700)		(73,059)	0	0	(73,759)
Net loss													0	0	0	0	(67,251)	(67,251)
Other comprehensive loss													$ 0	$ 0	0	(1,584)	0	$ (1,584)
Exercise of common stock options and warrants (in shares)													384,378	0				0
Exercise of common stock options and warrants													$ 4	$ 0	(212)	0	0	$ (208)
2025 Notes (in shares)	0	(21,144,825)					0	0
2025 Notes	$ 0	$ 0	$ 0	$ 0	$ 0	$ 0	$ 0	$ 0	$ 151,870	$ 0	$ 0	$ 151,870
Balance (in shares) at Sep. 30, 2024													712,283,206	(29,799,907)
Balance at September 30, 2024 at Sep. 30, 2024													$ 7,124	$ (1,791)	3,516,735	(39,614)	(2,079,037)	1,403,417
Balance (in shares) at Jun. 30, 2024													727,176,232	(29,799,907)
Balance at December 31, 2023 at Jun. 30, 2024													$ 7,273	$ (1,791)	3,540,414	(46,652)	(2,103,927)	1,395,317
Equity-based compensation expense													0	0	2,784	0	0	2,784
Repurchase of 2029 Convertible Notes													$ 0	0	(2,853)	0	0	(2,853)
Share repurchase (in shares)													(14,893,026)
Share repurchase													$ (149)		(23,610)	0	0	(23,759)
Net loss													0	0	0	0	24,890	24,890
Other comprehensive loss													$ 0	$ 0	0	7,038	0	$ 7,038
Exercise of common stock options and warrants (in shares)																		0
Balance (in shares) at Sep. 30, 2024													712,283,206	(29,799,907)
Balance at September 30, 2024 at Sep. 30, 2024													$ 7,124	$ (1,791)	$ 3,516,735	$ (39,614)	$ (2,079,037)	$ 1,403,417

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Cash Flows (Unaudited) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Cash flows from operating activities:
Net loss	$ (67,251)	$ (122,380)
Adjustments to reconcile net loss to net cash used in operating activities:
Depreciation and amortization	74,137	79,315
Non-cash interest	12,753	2,057
Amortization of debt issuance cost	1,328	908
Losses from investments in investees	7	99
Equity-based compensation – employees and non-employees	7,983	8,746
Realized loss (gain) on disposal of fixed assets and sales of equity securities	(9,489)	1,444
Change in fair value of equity securities and derivative instruments	(94,626)	14,406
Loss on conversion convertible senior notes	725	0
Contingent consideration	0	(1,023)
Deferred income tax (benefit) provision	7,695	7,307
Gain on sale of assets	(121,493)	0
Changes in assets and liabilities:
Accounts receivable, net	15,680	8,741
Inventory, net	6,452	4,082
Other current assets and prepaid expenses	(8,395)	10,220
Other assets	564	(2,666)
Accounts payable	(6,527)	191
Foreign currency measurement	(3,575)	24
Accrued expenses and other liabilities	44,952	(1,374)
Net cash (used in) provided by operating activities	(139,080)	10,097
Cash flows from investing activities:
Investments in investees	0	(5,000)
Proceeds from sale of equity securities	46,731	364
Purchase of marketable securities	(1,454)	0
Proceeds from the sale of property, plant and equipment	169	1,109
Capital expenditures	(19,597)	(13,253)
Proceeds from LabCorp Sale	210,378	0
Net cash provided by (used in) investing activities	236,227	(16,780)
Cash flows from financing activities:
Issuance of 3.00% convertible senior notes, net (including related parties)	230,000	0
Issuance of 2044 Notes	250,000	0
Issuance of 3.75% 2029 convertible notes, debt issuance cost	(13,385)	0
Share repurchase	(73,759)	0
Proceeds from the exercise of common stock options	(208)	(273)
Repurchase of 2029 Convertible Notes	(4,881)	0
Borrowings on lines of credit	448,459	515,318
Repayments of lines of credit	(465,301)	(519,597)
Redemption of 2025 Notes and 2033 Senior Notes	(146,287)	(3,000)
Net cash provided by (used in) financing activities	224,638	(7,552)
Effect of exchange rate changes on cash, cash equivalents and restricted cash	2,399	(335)
Net decrease in cash, cash equivalents and restricted cash	324,184	(14,570)
Cash, cash equivalents and restricted cash at beginning of period	95,881	153,191
Cash, cash equivalents and restricted cash at end of period	420,065	138,621
SUPPLEMENTAL INFORMATION:
Interest paid	12,982	10,748
Income taxes paid, net of refunds	3,801	(823)
Assets acquired by finance leases	0	713
Operating lease right-of-use assets in exchange for lease obligations	0	5,966
Non-cash financing:
Common stock options, warrants, and restricted stock units surrendered in net exercise	208	301
Fair value of shares received related to milestone achieved from GeneDx Holdings	$ 0	$ 6,689

Note 1 - Business and Organizat

Note 1 - Business and Organization	9 Months Ended
Note 1 - Business and Organization	Sep. 30, 2024
Notes to Financial Statements
Organization, Consolidation and Presentation of Financial Statements Disclosure [Text Block]	NOTE 1 OPKO Health, Inc., a Delaware corporation (“OPKO”, the “Company”, “we”, “us”, or “our”) is a diversified healthcare company that seeks to establish industry leading positions in large and rapidly growing medical markets. Our pharmaceutical business features Rayaldee 3 4 50 2022 Our diagnostics business, BioReference Health, LLC (“BioReference”), is a highly specialized laboratory in the United States, with a sales and marketing team focused on growth and new product integration, including the 4Kscore® 4Kscore September 16, 2024 The Company maintains established, revenue-generating pharmaceutical platforms in Spain, Ireland, Chile, and Mexico, contributing to positive cash flow and facilitating market entry for our development pipeline. In addition to these platforms, we operate a global pharmaceutical development and commercial supply company, a global supply chain operation, and manufacture specialty active pharmaceutical ingredients (API) in Israel through our subsidiary, FineTech. Our management team possesses extensive industry experience in development, regulatory affairs, and commercialization. Their industry relationships support the identification and pursuit of commercial opportunities. Research and development activities are primarily conducted in facilities located in Weston, Massachusetts, Waterford, Ireland, Kiryat Gat, Israel, and Barcelona, Spain. On March 27, 2024, September 16, 2024, Pursuant to the Labcorp Asset Purchase Agreement, a total of approximately $23.7 million was withheld at closing and deposited by Labcorp into an escrow account with an escrow account to satisfy potential indemnity claims. The escrow will be released to the Company on the twelve We recognized a gain of $121.5 million from the BioReference Transaction for the three nine September 30, 2024.

Note 2 - Foreign Exchange Rates

Note 2 - Foreign Exchange Rates	9 Months Ended
Note 2 - Foreign Exchange Rates	Sep. 30, 2024
Notes to Financial Statements
Unusual or Infrequent Items, or Both, Disclosure [Text Block]	NOTE 2 Foreign Currency Exchange Rates Approximately 22.3% of our revenue for the nine September 30, 2024 2023. nine September 30, 2024 December 31, 2023, September 30, 2024 December 31, 2023, We are subject to foreign currency transaction risk due to fluctuations in exchange rates between the time a transaction is initiated and settled. To mitigate this risk, we use foreign currency forward contracts. These contracts fix an exchange rate, allowing us to offset potential losses (or gains) caused by exchange rate changes at the settlement date. As of September 30, 2024 December 31, 2023, January 2024

Note 3 - Summary of Significant

Note 3 - Summary of Significant Accounting Policies	9 Months Ended
Note 3 - Summary of Significant Accounting Policies	Sep. 30, 2024
Notes to Financial Statements
Significant Accounting Policies [Text Block]	NOTE 3 Basis of presentation 10 10 X. not nine September 30, 2024 not may 2024 10 December 31, 2023 Principles of consolidation Use of estimates Cash, cash equivalents and restricted cash 90 90 The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the Condensed Consolidated Balance Sheet to the sum of such amounts in the Condensed Consolidated Statements of Cash Flows: September 30, 2024 December 31, 2023 Cash and cash equivalents $ 400,079 $ 95,881 Restricted cash, current 6,321 — Restricted cash, long-term 13,665 — Total cash, cash equivalents, and restricted cash shown in the Condensed Consolidated Statements of Cash Flows $ 420,065 $ 95,881 The Company classifies cash deposits related to letters of credit securing insurance and lease obligations as restricted cash, which is included in other assets, non-current, within the Consolidated Balance Sheet. Inventories first first three nine September 30, 2024 three nine September 30, 2023 Goodwill and intangible assets 5. September 30, 2024 December 31, 2023 Assets acquired and liabilities assumed in business combinations, licensing and other transactions are generally recognized at the date of acquisition at their respective fair values. Any excess of the purchase price over the estimated fair values of the net assets acquired is recognized as goodwill. At acquisition, we generally determine the fair value of intangible assets, including IPR&D, using the “income method.” Subsequent to their acquisition, goodwill and indefinite lived intangible assets are tested at least annually as of October 1 not may not Estimating the fair value of a reporting unit for goodwill impairment is highly sensitive to changes in projections and assumptions and changes in assumptions could potentially lead to impairment. We perform sensitivity analyses around our assumptions in order to assess the reasonableness of the assumptions and the results of our testing. Ultimately, potential changes in these assumptions may September 30, 2024 December 31, 2023 Net intangible assets other than goodwill were $836.4 million on each of September 30, 2024 December 31, 2023 may Upon regulatory approval, IPR&D assets are classified as finite-lived intangible assets. These assets are then amortized on a straight-line basis over their estimated useful lives. If a project is abandoned, the associated IPR&D costs are immediately expensed. We also regularly assess finite-lived intangible assets for impairment. This assessment involves comparing the carrying amount of an asset, which is its cost minus accumulated amortization, to its estimated future undiscounted cash flows. If the carrying amount exceeds the estimated future cash flows, an impairment charge is recognized to reflect the difference between the asset's carrying amount and its fair value. While we believe our estimates and assumptions used in impairment testing (including for goodwill and IPR&D) are reasonable and reflect those used by market participants, there is a potential risk of material impairment charges. Based on the current financial performance of our diagnostics segment and our Ireland reporting unit (which includes Eirgen and Rayaldee September 30, 2024 December 31, 2023 We amortize intangible assets with definite lives on a straight-line basis over their estimated useful lives, ranging from 3 to 20 years. We use the straight-line method of amortization as there is no three nine September 30, 2024 three nine September 30, 2023 Fair value measurements September 30, 2024 December 31, 2023 In evaluating the fair value information, considerable judgment is required to interpret the market data used to develop the estimates. The use of different market assumptions and/or different valuation techniques may may not 9. Contingent consideration may may Derivative financial instruments September 30, 2024 December 31, 2023 not 10. 2029 144A 7 7. 9. Property, plant and equipment three nine September 30, 2024 three nine September 30, 2023 Impairment of long-lived assets. may not Income taxes. not not We operate in various countries and tax jurisdictions globally. For interim reporting purposes, we record income taxes based on the expected effective income tax rate, taking into consideration year to date and global forecasted tax results. For the nine September 30, 2024 not Included in Other long-term liabilities is an accrual of $9.9 million related to uncertain tax positions involving income recognition. In connection with an examination of foreign tax returns for the 2015 2021 no Revenue recognition 606, Revenue from Contracts with Customers 606” five We apply the five 606, 13. Concentration of credit risk and allowance for credit losses While we have receivables due from federal and state governmental agencies, such receivables are not September 30, 2024 December 31, 2023 September 30, 2024 December 31, 2023 We assess the collectability of accounts receivable balances by considering factors such as historical collection experience, customer credit worthiness, the age of accounts receivable balances, regulatory changes and current economic conditions and trends that may September 30, 2024 December 31, 2023 three nine September 30, 2024 three nine September 30, 2023 As of September 30, 2024 14 December 31, 2023, 13, 14, Stock Repurchase Program. July 18, 2024, may 10b5 1 not no may three September 30, 2024. Equity-based compensation three nine September 30, 2024 three nine September 30, 2023 Research and development expenses third third Research and development expense includes costs for in-process research and development projects acquired in asset acquisitions which have not no Segment reporting two Rayaldee no no 15. Shipping and handling costs. not Foreign currency translation three nine September 30, 2024 three nine September 30, 2023 Variable interest entities 6. Investments 6. not 6. Accounting standards yet to be adopted. In December 2023, No. 2023 09, 740 2023 09” 2023 09 December 15, 2024. not 2023 09 In November 2023, No 2023 07, 280 2023 07” 2023 07 280. 280 December 15, 2024 Recently adopted accounting standards In 2021, two 15% December 15, 2022, 15%. 2024 2025. no 2024,

Note 4 - Earnings (Loss) Per Sh

Note 4 - Earnings (Loss) Per Share	9 Months Ended
Note 4 - Earnings (Loss) Per Share	Sep. 30, 2024
Notes to Financial Statements
Earnings Per Share [Text Block]	NOTE 4 Basic income (loss) per share is computed by dividing our net income (loss) by the weighted average number of shares of our Common Stock outstanding during the period. Shares of Common Stock outstanding under the share lending arrangement entered into in conjunction with the 2025 7 January 22, 2024. 7. 2029 2033 2023 2025 7 no 2029 2033 2023 2025 For the three months ended September 30, For the nine months ended September 30, (In thousands, except per share data) 2024 2023 2024 2023 Numerator Net income (loss), basic $ 24,890 $ (84,473 ) $ (67,251 ) $ (122,380 ) Add: Interest on 2025 Notes 1 - - - Add: Interest on 2029 Convertible Notes 6,858 - - - Add: Loss on buy back of 2029 Convertible Notes 32 - - - Net income (loss), diluted $ 31,781 $ (84,473 ) $ (67,251 ) $ (122,380 ) Denominator (Shares in thousands) Weighted average common shares outstanding, basic 694,622,466 751,525,007 699,675,944 751,716,692 Effect of dilutive securities: Stock options 76,922 - - - Warrants - - - - 2025 Notes 48,295 - - - 2023 Convertible Notes - - - - 2033 Senior Notes 8,489 - - - 2029 Convertible Notes 303,607,464 Dilutive potential shares 303,741,170 - - - Weighted average common shares outstanding, diluted 998,363,636 751,525,007 699,675,944 751,716,692 Loss per share, basic $ 0.04 $ (0.11 ) $ (0.10 ) $ (0.16 ) Loss per share, diluted $ 0.03 $ (0.11 ) $ (0.10 ) $ (0.16 ) A total of 0 and 83,074,689 potential shares of Common Stock were excluded from the calculation of diluted net loss per share for the three September 30, 2024 2023 nine September 30, 2024 2023 During the three September 30, 2024 During the nine September 30, 2024 During the three September 30, 2023 During the nine September 30, 2023

Note 5 - Composition of Certain

Note 5 - Composition of Certain Financial Statement Captions	9 Months Ended
	Sep. 30, 2024
Notes to Financial Statements
Supplemental Balance Sheet Disclosures [Text Block]	NOTE 5 September 30, December 31, (In thousands) 2024 2023 Accounts receivable, net: Accounts receivable $ 108,583 $ 125,379 Less: allowance for credit losses (2,004 ) (2,000 ) $ 106,579 $ 123,379 Inventories, net: Consumable supplies $ 16,218 $ 25,864 Finished products 34,206 35,582 Work in-process 2,265 1,731 Raw materials 10,491 8,981 Less: inventory reserve (3,772 ) (6,461 ) $ 59,408 $ 65,697 Other current assets and prepaid expenses: Escrow receivable $ 23,750 $ — Taxes recoverable 6,767 4,211 Prepaid expenses 9,572 6,177 Prepaid insurance 6,302 3,848 Other receivables 1,563 2,610 Other 9,295 7,673 $ 57,249 $ 24,519 Intangible assets, net: Customer relationships $ 258,048 $ 315,799 Technologies 818,971 831,509 Trade names 49,759 49,758 Covenants not to compete 12,917 12,916 Licenses 6,311 6,205 Product registrations 6,738 6,790 Other 6,052 6,000 Less: accumulated amortization (517,400 ) (488,694 ) $ 641,396 $ 740,283 Accrued expenses: Employee benefits and severance $ 38,474 $ 28,952 Clinical trials 3,725 7,624 Commitments and contingencies 11,141 8,088 Accrued interest 6,021 2,601 Gross to net provision 6,033 9,420 Inventory received but not invoiced 2,306 1,653 Finance leases short-term 1,855 2,827 Professional fees 4,375 3,470 Taxes payable 15,334 1,384 Royalties 767 1,544 Commissions 1,521 1,822 Other 31,254 20,701 $ 122,806 $ 90,086 Other long-term liabilities: Employee severance $ 16,284 $ — Mortgages and other debts payable 3,529 7,709 Finance leases long-term 4,689 7,274 Contract liabilities 7 7 Other 11,995 12,199 $ 36,504 $ 27,189 Our intangible assets and goodwill relate principally to our completed acquisitions of OPKO Renal, OPKO Biologics, EirGen, BioReference and ModeX. We amortize intangible assets with definite lives on a straight-line basis over their estimated useful lives. The estimated useful lives by asset class are as follows: technologies - 7-17 years, customer relationships - 5-20 years, product registrations - 7-10 years, covenants not not not Changes in value of the intangible assets and goodwill during the nine September 30, 2024 2023 The following table summarizes the changes in Goodwill by reporting unit during the nine September 30, 2024 2024 (In thousands) Gross goodwill at January 1, 2024 Cumulative impairment at January 1 Acquisitions, dispositions and other Foreign exchange and other Balance at September 30, 2024 Pharmaceuticals CURNA $ 4,827 $ (4,827 ) $ — $ — $ — Rayaldee 84,273 — — 925 85,198 FineTech 11,698 (11,698 ) — — — ModeX 80,260 — — — 80,260 OPKO Biologics 139,784 — — (0 ) 139,784 OPKO Chile 3,642 — — (81 ) 3,561 OPKO Health Europe 7,276 — — 82 7,358 OPKO Mexico 100 (100 ) — — — Transition Therapeutics 3,421 (3,421 ) — — — Diagnostics BioReference 283,025 — (63,318 ) — 219,707 OPKO Diagnostics 17,977 (17,977 ) — — — $ 636,283 $ (38,023 ) $ (63,318 ) $ 926 $ 535,868

Note 6 - Investments

Note 6 - Investments	9 Months Ended
Note 6 - Investments	Sep. 30, 2024
Notes to Financial Statements
Investment [Text Block]	NOTE 6 Investments The following table reflects the accounting method, carrying value and underlying equity in net assets of our unconsolidated investments as of September 30, 2024 December 31, 2023 (in thousands) As of September 30, 2024 As of December 31, 2023 Investment type Investment Carrying Value Underlying Equity in Net Assets Investment Carrying Value Underlying Equity in Net Assets Equity method investments $ (0 ) $ 1,782 $ (0 ) $ 2,942 Variable interest entity, equity method 790 — 796 420 Equity method investments - FV option 92,166 9,786 Equity securities 130 116 Equity securities with no readily determinable fair value 7,521 5,382 Warrants and options 2 2 Total carrying value of investments $ 100,609 $ 16,082 Equity method investments Our equity method investments, other than in GeneDx Holdings, as described below, consist of investments in Pharmsynthez (ownership 6%), Cocrystal Pharma, Inc. (“COCP”) (2%), Non-Invasive Monitoring Systems, Inc. (“NIMS”) (1%), BioCardia, Inc. (“BioCardia”) (1%), Xenetic Biosciences, Inc. (“Xenetic”) (3%), Zebra Biologics, Inc. (“Zebra”) (29%), and LeaderMed Health Group Limited (“LeaderMed”) (47%). Neovasc, Inc., in which we owned a 0.5% interest, was acquired by Shockwave Medical, Inc. in April 2023. nine September 30, 2024 December 31, 2023 September 30, 2024 December 31, 2023 Equity method investments - Fair value option On January 14, 2022, Sema4 April 28, 2022. third 2024, September 30, 2024. Pursuant to the GeneDx Merger Agreement, the Company designated, and GeneDx Holdings nominated for election an individual to serve on the board of directors of GeneDx Holdings. This individual was subsequently elected by GeneDx Holdings stockholders and has continued to serve on the board following his re-election in 2024. 2027. We account for our investment in GeneDx Holdings under the equity method fair value option and record gains and losses from changes in fair value in other income (expense), net in our Condensed Consolidated Statements of Operations. For the three nine September 30, 2024 three nine September 30, 2023 September 30, 2024 Investments in equity securities Our equity securities consist of investments in VBI Vaccines Inc. (0.00%), ChromaDex Corporation (“ChromaDex”) (0.05%), and Eloxx Pharmaceuticals, Inc. (“Eloxx”) (1%). During the third 2024, CAMP4 “CAMP4” not nine September 30, 2024 2023 For the nine months ended September 30, (in thousands) 2024 2023 Equity Securities: Net gains and losses recognized during the period on equity securities $ 43 $ (411 ) Less: Net gains and losses realized during the period on equity securities (30 ) — Unrealized net losses recognized during the period on equity securities still held at the reporting date $ 13 $ (411 ) Sales of investments Gains (losses) included in earnings from sales of our investments are recorded in Other income (expense), net in our Condensed Consolidated Statement of Operations. The cost of securities sold is based on the specific identification method. Warrants and options In addition to our equity method investments and equity securities, we hold options to purchase 47 thousand additional shares of BioCardia, all of which were vested as of September 30, 2024 December 31, 2023 9 10. Investments in variable interest entities We have determined that we hold variable interests in LeaderMed and Zebra. We made this determination as a result of our assessment that they do not In September 2021, two eight OPK88003, In order to determine the primary beneficiary of the joint venture, we evaluated our investment and our related parties’ investment, as well as our investment combined with the related parties’ investment to identify if we had the power to direct the activities that most significantly impact the economic performance of the joint venture. Based on the capital structure, governing documents and overall business operations of the joint venture, we determined that, while a VIE, we do not not We own 1,260,000 shares of Zebra’s Series A- 2 September 30, 2024 December 31, 2023 In order to determine the primary beneficiary of Zebra, we evaluated our investment and our related parties’ investment, as well as our investment combined with the related parties’ investment to identify if we had the power to direct the activities that most significantly impact the economic performance of Zebra. Based on the capital structure, governing documents and overall business operations of Zebra, we determined that, while a VIE, we do not no

Note 7 - Debt

Note 7 - Debt	9 Months Ended
Note 7 - Debt	Sep. 30, 2024
Notes to Financial Statements
Debt Disclosure [Text Block]	NOTE 7 As of September 30, 2024 December 31, 2023 September 30, December 31, (In thousands) 2024 2023 2029 Convertible Notes $ 178,645 $ — 2025 Notes 170 143,250 2033 Senior Notes 50 50 2023 Convertible Notes — 71,025 2044 Notes 245,358 — JPMorgan Chase Bank line of credit — 12,671 Chilean and Spanish lines of credit 11,713 12,629 Current portion of notes payable 1,509 1,993 Long term portion of notes payable 3,529 7,727 Total $ 440,974 $ 249,345 Balance sheet captions Current portion of convertible notes $ 170 $ — Long term portion of convertible notes 178,695 214,325 Current portion of lines of credit and notes payable 13,222 27,293 Long Term notes payable included in long-term liabilities 248,887 7,727 Total $ 440,974 $ 249,345 2044 On July 17, 2024, “2044 July 17, 2024 ( “2044 “2044 The 2044 July 17, 2044 3 2044 14 2044 2044 2044 2044 2044 July 17, 2029, 2044 July 17, 2029. 2044 not may 2044 may 2044 2044 2044 2044 2044 2044 2044 2029 144A In January 2024, 2029 “2029 144A “144A Net proceeds from the 2029 144A 2029 144A January 4, 2024. Contemporaneously with the closing of the offering of the 2029 144A January 9, 2024, 2029 “2029 2029 144A “2029 January 4, 2024 ( 2029 2023 On January 9th, 2024, 2029 From the date the Notes were issued through March 31, 2024, April 1, 2024, 2029 As of September 30, 2024 2029 144A may 2029 September 15, 2028 1 March 31, 2024 ( not 2 $1,000 3 2029 September 15, 2028 may may The conversion rate is initially equal to 869.5652 shares of Common Stock per $1,000 2029 not 2029 We may not may plus 2029 not The indenture governing the notes provides for customary events of default which include (subject in certain cases to customary grace and cure periods), among others, the following: nonpayment of principal or interest; breach of covenants or other agreements in the indenture; defaults in failure to pay certain other indebtedness; judgment defaults; and certain events of bankruptcy or insolvency. Generally, if an event of default occurs and is continuing under the indenture, the trustee thereunder or the holders of at least 25% in aggregate principal amount of the notes then outstanding may may, The following table sets forth information related to the 2029 September 30, 2024 (In thousands) 2029 convertible notes Embedded conversion option Discount Debt Issuance costs Total Balance at December 31, 2023 $ — $ — $ — $ — $ — Issuance of 3.75 301,054 125,620 (125,620 ) (8,562 ) 292,492 Amortization of debt discount and debt issuance costs — — 12,585 1,236 13,821 Change in fair value of embedded derivative — 26,250 — — 26,250 Reclassification of embedded derivative to equity — (151,870 ) — — (151,870 ) Repurchase (3,500 ) — 1,338 114 (2,048 ) Balance at September 30, 2024 $ 297,554 $ — $ (111,697 ) $ (7,212 ) $ 178,645 During the third 2024, 2029 144A 2025 In February 2019, 2025 “2025 2025 February 15 August 15 2025 February 15, 2025, In May 2021, 2025 2025 Contemporaneously with the closing of our offering of the 2029 2025 2029 2025 On January 22, 2024, February 4, 2019, 2019 2025 2023 In February 2018, “2023 2023 five 2023 2023 On February 10, 2023, 2023 January 31, 2025 10 2023 In connection with the closing of the 2029 2029 2023 2023 2033 In January 2013, 2033 “2033 2033 February 1 August 1 February 1, 2033, 2013 2016, 2033 February 1, 2019, 2033 2033 first 2023, 2033 2033 2033 JPMorgan Chase Credit Agreement In November 2015, On September 16, 2024, no The Credit Agreement had been guaranteed by all of BioReference’s domestic subsidiaries and secured by substantially all assets of BioReference and its domestic subsidiaries, as well as a non-recourse pledge by us of our equity interest in BioReference. All guarantees and security interests were released together with the termination of the Credit Agreement. As of December 31, 2023 International Line of Credit Agreements The Company has line of credit agreements with twelve September 30, 2024 December 31, 2023 The following table summarizes the amounts outstanding under the BioReference, Chilean and Spanish lines of credit: (Dollars in thousands) Balance Outstanding Interest rate on borrowings at Credit line September 30, December 31, Lender September 30, 2024 capacity 2024 2023 JPMorgan Chase 0.00 % $ — $ — $ 12,671 Itau Bank 5.50 % 1,900 469 1,264 Bank of Chile 6.60 % 2,500 711 1,728 BICE Bank 5.50 % 2,500 2,433 1,734 Scotiabank 5.00 % 5,500 3,060 981 Santander Bank 5.50 % 5,000 1,742 450 Security Bank 5.50 % 1,400 — — Estado Bank 5.50 % 4,000 1,355 3,303 BCI Bank 5.00 % 2,500 346 1,626 Internacional Bank 5.50 % 1,597 1,597 1,197 Consorcio Bank 5.00 % 2,000 — 346 Banco De Sabadell 1.75 % 558 — — Santander Bank 5.36 % 558 — — Total $ 30,013 $ 11,713 $ 25,300 At September 30, 2024 December 31, 2023 At September 30, 2024 December 31, 2023 2033 2023 2025 September 30, December 31, (In thousands) 2024 2023 Current portion of notes payable $ 1,509 $ 1,993 Other long-term liabilities 3,529 7,727 Total $ 5,038 $ 9,720 The notes and other debt mature at various dates ranging from 2024 2032, September 30, 2024 December 31, 2023

Note 8 - Accumulated Other Comp

Note 8 - Accumulated Other Comprehensive Loss	9 Months Ended
Note 8 - Accumulated Other Comprehensive Loss	Sep. 30, 2024
Notes to Financial Statements
Comprehensive Income (Loss) Note [Text Block]	NOTE 8 For the nine September 30, 2024 Foreign currency (In thousands) translation Balance at December 31, 2023 $ (38,030 ) Other comprehensive loss (1,585 ) Balance at September 30, 2024 $ (39,615 )

Note 9 - Fair Value Measurement

Note 9 - Fair Value Measurements	9 Months Ended
Note 9 - Fair Value Measurements	Sep. 30, 2024
Notes to Financial Statements
Fair Value Disclosures [Text Block]	NOTE 9 We record fair values at an exit price, representing the amount that would be received to sell an asset or paid to transfer a liability in an orderly transaction between market participants. As such, fair value is a market-based measurement determined based on assumptions that market participants would use in pricing an asset or liability. We utilize a three 1, 2, 3, no As of September 30, 2024 6 10 1 Our financial assets and liabilities measured at fair value on a recurring basis are as follows: Fair value measurements as of September 30, 2024 Quoted prices in active Significant markets for other Significant identical observable unobservable assets inputs inputs (In thousands) (Level 1) (Level 2) (Level 3) Total Assets: Money market funds $ 354,537 $ — $ — $ 354,537 Equity securities 130 — — 130 Equity Method - Fair value option 92,166 — — 92,166 Common stock options — 2 — 2 Total assets $ 446,833 $ 2 $ — $ 446,835 Fair value measurements as of December 31, 2023 Quoted prices in active Significant markets for other Significant identical observable unobservable assets inputs inputs (In thousands) (Level 1) (Level 2) (Level 3) Total Assets: Money market funds $ 32,404 $ — $ — $ 32,404 Equity securities 116 — — $ 116 Equity Method - fair value option 9,786 — — 9,786 Common stock options/warrants — 2 — 2 Total assets $ 42,306 $ 2 $ — $ 42,308 Liabilities: Forward contracts — 29 — 29 Total liabilities $ — $ 29 $ — $ 29 The carrying amount and estimated fair value of our 2029 2025 2029 2025 September 30, 2024 Carrying Total (In thousands) Value Fair Value Level 1 Level 2 Level 3 2029 Convertible Notes $ 178,645 $ 396,652 $ — $ 396,652 $ — 2025 Notes $ 170 $ 170 $ — $ 170 $ — There have been no 1 2 no 3 . The following table reconcile the beginning and ending balances of our Level 3 September 30, 2024 September 30, 2024 Embedded conversion (In thousands) option Balance at December 31, 2023 $ — Additions 125,620 Change in fair value: Included in results of operations 26,250 Reclassification of embedded derivatives to equity (151,870 ) Balance at September 30, 2024 $ —

Note 10 - Derivative Contracts

Note 10 - Derivative Contracts	9 Months Ended
Note 10 - Derivative Contracts	Sep. 30, 2024
Notes to Financial Statements
Derivative Instruments and Hedging Activities Disclosure [Text Block]	NOTE 10 The following table summarizes the fair values and the presentation of our derivative financial instruments in the Condensed Consolidated Balance Sheets: Balance Sheet September 30, December 31, (In thousands) Component 2024 2023 Derivative financial instruments: Common Stock options/warrants Investments, net $ 2 $ 2 Forward contracts Unrealized losses on forward contracts are recorded in Accrued expenses. $ — $ (29 ) We enter into foreign currency forward exchange contracts with respect to the risk of exposure to exchange rate differences arising from inventory purchases on letters of credit. Under these forward contracts, for any rate above or below the fixed rate, we receive or pay the difference between the spot rate and the fixed rate for the given amount at the settlement date. To qualify the derivative instrument as a hedge, we are required to meet strict hedge effectiveness and contemporaneous documentation requirements at the initiation of the hedge and assess the hedge effectiveness on an ongoing basis over the life of the hedge. At September 30, 2024 December 31, 2023 not three nine September 30, 2024 2023 Three months ended September 30, Nine months ended September 30, (In thousands) 2024 2023 2024 2023 Derivative gain (loss): Notes $ — $ — $ (26,250 ) $ — Common Stock options/warrants (1 ) (37 ) 1 (27 ) Forward contracts — 125 88 (802 ) Total $ (1 ) $ 88 $ (26,161 ) $ (829 )

Note 11 - Related Party Transac

Note 11 - Related Party Transactions	9 Months Ended
Note 11 - Related Party Transactions	Sep. 30, 2024
Notes to Financial Statements
Related Party Transactions Disclosure [Text Block]	NOTE 11 We lease office space from Frost Real Estate Holdings, LLC (“Frost Holdings”) in Miami, Florida, where our principal executive offices are located. Effective August 1, 2024, first fifth In January 2024, 2029 2029 2023 7 On October 12, 2023, 20% October 2024 2026, On May 4, 2023, On April 29, 2022, August 31, 2023, September 30, 2024 three nine September 30, 2024 not September 30, 2024 not The Company owns approximately 6% of Pharmsynthez and Pharmsynthez is the largest and controlling shareholder of Xenetic, in which the Company has a 3% ownership interest. Adam Logal, our Senior Vice President and Chief Financial Officer, is a director of Xenetic. We hold investments in Zebra (ownership 29%), ChromaDex (0.05%), COCP (2%), NIMS (1%), Eloxx (1%), BioCardia (1%) and LeaderMed (47%). Neovasc, Inc., in which we owned a 0.5% interest, was acquired by Shockwave Medical, Inc. in April 2023, third 2023, 6. Dr. Elias Zerhouni, our Vice Chairman and President, sits on the board of directors of Danaher Corporation (“Danaher”). Our subsidiary, BioReference, routinely procures products and services from several subsidiaries of Danaher, including Beckman Coulter, Integrated DNA Technologies Inc., and Leica Microsystems Inc., to which BioReference has paid $2.6 million, $3.3 million, and $0.3 million, respectively, during the nine September 30, 2024 BioReference purchases and uses certain products acquired from InCellDx, a company in which we hold a 29% minority interest. We reimburse Dr. Frost for Company-related use by Dr. Frost and our other executives of an airplane owned by a company that is beneficially owned by Dr. Frost. We reimburse Dr. Frost for out-of-pocket operating costs for the use of the airplane by Dr. Frost or Company executives for Company-related business. We do not three nine September 30, 2024 three nine September 30, 2023

Note 12 - Commitments and Conti

Note 12 - Commitments and Contingencies	9 Months Ended
Note 12 - Commitments and Contingencies	Sep. 30, 2024
Notes to Financial Statements
Commitments and Contingencies Disclosure [Text Block]	NOTE 12 In February 2023, 2005 may On December 29, 2022, 2014 2020 may not no The Company and BioReference entered into (i) a settlement agreement (the “Settlement Agreement”), effective July 14, 2022, July 14, 2022 ( Under the Settlement Agreement, the Company and BioReference admitted only to having made payments to certain physicians and physicians’ groups for office space rentals for amounts that exceeded fair market value, and that it did not 2015. September 24, 2021 July 18, 2022. Under the CIA, which has a term of 5 not On March 1, 2019, January 13, 2022, February 9, 2022, February 17, 2022, April 25, 2022 March 2023. April 2023 second April 2024. From time to time, we may may may may may may We are a party to other litigation in the ordinary course of business. While we cannot predict the ultimate outcome of legal matters, we accrue a liability for legal contingencies when we believe that it is both probable that a liability has been incurred and that we can reasonably estimate the amount of the loss. It’s reasonably possible the ultimate liability could exceed amounts currently estimated and we review established accruals and adjust them to reflect ongoing negotiations, settlements, rulings, advice of legal counsel and other relevant information. To the extent new information is obtained and our views on the probable outcomes of claims, suits, assessments, investigations or legal proceedings change, changes in our accrued liabilities would be recorded in the period in which such determination is made. Because of the high degree of judgment involved in establishing loss estimates, the ultimate outcome of such matters will differ from our estimates and such differences may At September 30, 2024 2024

Note 13 - Revenue Recognition

Note 13 - Revenue Recognition	9 Months Ended
Note 13 - Revenue Recognition	Sep. 30, 2024
Notes to Financial Statements
Revenue from Contract with Customer [Text Block]	NOTE 13 We generate revenues from services, products and intellectual property as follows: Revenue from services Revenue for laboratory services is recognized at the time test results are reported, which approximates when services are provided and the performance obligations are satisfied. Services are provided to patients covered by various third The following are descriptions of our payors for laboratory services: Healthcare Insurers. third Government Payors. Client Payors. Patients. The complexities and ambiguities of billing, reimbursement regulations and claims processing, as well as considerations unique to Medicare and Medicaid programs, require us to estimate the potential for retroactive adjustments as an element of variable consideration in the recognition of revenue in the period the related services are rendered. Actual amounts are adjusted in the period those adjustments become known. For the nine September 30, 2024 2023 Third-party payors, including government programs, may not may may third third As an integral part of our billing compliance program, we periodically assess our billing and coding practices, respond to payor audits on a routine basis, and investigate reported failures or suspected failures to comply with federal and state healthcare reimbursement requirements, as well as overpayment claims which may may third Settlements with third no September 30, 2024 December 31, 2023 The composition of revenue from services by payor for the three nine September 30, 2024 2023 Three months ended September 30, Nine months ended September 30, (In thousands) 2024 2023 2024 2023 Healthcare insurers $ 76,184 $ 81,469 $ 229,600 $ 238,934 Government payers 20,368 19,909 63,561 61,250 Client payers 20,773 25,906 71,521 77,973 Patients 3,946 4,395 12,875 12,943 Total $ 121,271 $ 131,679 $ 377,557 $ 391,100 Revenue from products We recognize revenue from product sales when a customer obtains control of promised goods or services. The amount of revenue recorded reflects the consideration that we expect to receive in exchange for those goods or services. Our estimates for sales returns and allowances are based upon the historical patterns of product returns and allowances taken, matched against the sales from which they originated, and our evaluation of specific factors that may may Rayaldee Rayaldee Rayaldee Rayaldee We recognize revenue for shipments of Rayaldee three nine September 30, 2024 Rayaldee three nine September 30, 2023 Rayaldee The following table presents an analysis of Rayaldee three nine September 30, 2024 2023 (In thousands) Chargebacks, discounts, rebates and fees Governmental Returns Total Balance at June 30, 2024 $ 2,743 $ 5,991 $ 2,194 $ 10,928 Provision related to current period sales 4,005 5,776 317 10,098 Credits or payments made (5,058 ) (7,013 ) (278 ) (12,349 ) Balance at September 30, 2024 $ 1,690 $ 4,754 $ 2,233 $ 8,677 Total gross Rayaldee sales $ 15,865 Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales 64 % (In thousands) Chargebacks, discounts, rebates and fees Governmental Returns Total Balance at December 31, 2023 $ 2,578 $ 6,150 $ 2,192 $ 10,920 Provision related to current period sales 12,224 16,325 989 29,538 Credits or payments made (13,112 ) (17,721 ) (948 ) (31,781 ) Balance at September 30, 2024 $ 1,690 $ 4,754 $ 2,233 $ 8,677 Total gross Rayaldee sales $ 49,447 Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales 60 % (In thousands) Chargebacks, discounts, rebates and fees Governmental Returns Total Balance at June 30, 2023 $ 2,330 $ 5,954 $ 1,634 $ 9,918 Provision related to current period sales 3,446 4,998 322 8,766 Credits or payments made (4,125 ) (4,207 ) (15 ) (8,347 ) Balance at September 30, 2023 $ 1,651 $ 6,745 $ 1,941 $ 10,337 Total gross Rayaldee sales $ 16,090 Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales 54 % (In thousands) Chargebacks, discounts, rebates and fees Governmental Returns Total Balance at December 31, 2022 $ 1,532 $ 5,063 $ 1,683 $ 8,278 Provision related to current period sales 10,702 14,604 959 26,265 Credits or payments made (10,583 ) (12,922 ) (701 ) (24,206 ) Balance at September 30, 2023 $ 1,651 $ 6,745 $ 1,941 $ 10,337 Total gross Rayaldee sales $ 47,940 Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales 55 % Taxes collected from customers related to revenues from services and revenues from products are excluded from revenues. Revenue from intellectual property and other We recognize revenues from the transfer of intellectual property generated through license, development, collaboration and/or commercialization agreements. The terms of these agreements typically include payment to us for one For research, development and/or commercialization agreements that result in revenues, we identify all material performance obligations, which may not Upfront License Fees: If a license to our intellectual property is determined to be functional intellectual property distinct from the other performance obligations identified in the arrangement, we recognize revenue from nonrefundable, upfront license fees based on the relative value prescribed to the license compared to the total value of the arrangement. The revenue is recognized when the license is transferred to the customer and the customer is able to use and benefit from the license. For licenses that are not Research and Development Activities: If we are entitled to reimbursement from our customers for specified research and development expenses, we account for them as separate performance obligations if distinct. We also determine whether the research and development funding would result in revenues or an offset to research and development expenses in accordance with provisions of gross or net revenue presentation. The corresponding revenues or offset to research and development expenses are recognized as the related performance obligations are satisfied. BARDA Contract: Revenue from the BARDA Contract is generated under terms that are cost plus fee. We recognize revenue using the incurred costs output method to measure progress. Revenue will only be recognized when research and development services are performed to the extent of actual costs incurred. Sales-based Milestone and Royalty Payments: Our customers may Other Potential Products and Services: Arrangements may not For the three September 30, 2024 three September 30, 2023 14 2023. For the nine September 30, 2024 nine September 30, 2023 one 2023, $90.0 Rayaldee 14 nine September 30, 2024 2023, 2024

Note 14 - Strategic Alliances

Note 14 - Strategic Alliances	9 Months Ended
Note 14 - Strategic Alliances	Sep. 30, 2024
Notes to Financial Statements
Collaborative Arrangement Disclosure [Text Block]	NOTE 14 Biomedical Advanced Research and Development Authority On September 28, 2023 , 19, In September 2024, two 19 1 2 As part of the research program, gene-based delivery methods for the multispecific antibodies will be developed using mRNA or DNA vectors to leverage the body's natural protein production processes. BARDA will make periodic progress assessments, and the continuation of the BARDA Contract depends on ModeX’s performance, the timeliness and quality of deliverables, and other factors. The BARDA Contract contains customary government contract provisions, including BARDA's right to terminate the contract in its discretion. The Company evaluated the BARDA Contract under ASC Topic 606, Revenue from Contracts with Customers 606” The Company identified three 19; 19 not not not The Company concluded that research and development services performed under the BARDA Contract would be recognized as revenue when research and development services are performed to the extent of actual costs incurred including a fixed fee and will be reimbursed by BARDA. Costs incurred represent work performed, which corresponds with, and thereby best depicts, the transfer of control of the research and development to BARDA. Types of contract costs include labor, material, and third three nine September 30, 2024 September 30, 2024 February 2028. Merck On March 8, 2023, Under the terms of the Merck Agreement, ModeX granted to Merck an exclusive, sublicensable, royalty-bearing license to certain intellectual property to develop, manufacture, use and commercialize (i) a multivalent or monovalent vaccine assembled using our platform for Epstein-Barr Virus (“Vaccine”), and (ii) any pharmaceutical or biological preparation in final form containing a Vaccine for sale or for administration to human patients in a clinical trial for all uses (“Product”). We received an initial payment of $50.0 million and are eligible to receive up to an additional $872.5 million upon the achievement of certain commercial and development milestones under several indications. We are also eligible to receive tiered royalty payments ranging from high single digits to low double digits upon achievement of certain sales targets of the Product. Certain of the rights subject to the license provided by us under the Merck Agreement were obtained by us from Sanofi pursuant to that certain License Agreement entered into as of July 1, 2021 ( may three September 30, 2023 As part of their strategic collaboration, ModeX and Merck have put in place a research plan to manage research and other development activities related to the development of a Vaccine or Product including a joint steering committee to facilitate the research program. As part of the research plan, they will use a third The Merck Agreement will remain in effect until one may not LeaderMed On September 14, 2021, two eight Under the terms of the agreements, we have granted the joint venture exclusive rights to develop, manufacture and commercialize (a) OPK88003, 2021 LeaderMed is responsible for funding the joint venture’s operations, development and commercialization efforts and, together with its syndicate partners, initially invested $11 million in exchange for a 53% ownership interest. We retain full rights to oxyntomodulin and Factor VIIa-CTP in all other geographies. CAMP4 On July 6, 2021, “CAMP4 CAMP4, CAMP4 one CAMP4 We received an initial upfront payment of $1.5 million and 3,373,008 shares of CAMP4’s CAMP4, may CAMP4 CAMP4 The Company was notified that the FDA placed the Dravet clinical trials on hold and CAMP4 NICOYA Macau Limited On June 18, 2021, Rayaldee EirGen received an initial upfront payment of $5 million and was eligible to receive an additional $5 million tied to the first March 2023. Nicoya is, at its sole cost and expense, responsible for performing all development activities necessary to obtain all regulatory approvals for the Nicoya Product in the Nicoya Territory and will be responsible for all commercial activities pertaining to the Nicoya Product in the Nicoya Territory. Unless earlier terminated, the Nicoya Agreement will remain in effect until such time as all royalty payment terms and extended payment terms have expired, and Nicoya shall have no ten first VFMCRP In May 2016, Rayaldee x In January 2023, Rayaldee 2022, first Rayaldee Effective May 23, 2021, Effective May 5, 2020, first Rayaldee Rayaldee We plan to share responsibility with VFMCRP for the conduct of trials specified within an agreed-upon development plan, with each company leading certain activities within the plan. EirGen will lead the manufacturing activities within and outside the VFMCRP Territory and the commercialization activities outside the VFMCRP Territory and outside the VFMCRP Field in the VFMCRP Territory and VFMCRP will lead the commercialization activities in the VFMCRP Territory and the VFMCRP Field. For the initial development plan, the companies have agreed to certain cost sharing arrangements. VFMCRP will be responsible for all other development costs that VFMCRP considers necessary to develop the Product for the use of the Product for the VFMCRP Initial Indication in the VFMCRP Territory in the VFMCRP Field except as otherwise provided in the VFMCRP Agreement. The first September 2018. In connection with the VFMCRP Agreement, the parties entered into a letter agreement pursuant to which EirGen granted to VFMCRP an exclusive option (the “Option”) to acquire an exclusive license under certain EirGen patents and technology to use, import, offer for sale, sell, distribute and commercialize the Product in the U.S. solely for the treatment of SHPT in dialysis patients with CKD and vitamin D insufficiency (the “Dialysis Indication”). Upon exercise of the Option, VFMCRP has agreed to reimburse EirGen for all of the development costs incurred by EirGen with respect to the Product for the Dialysis Indication in the U.S. VFMCRP would also pay EirGen up to an additional aggregate amount of $555 million of sales-based milestones upon the achievement of certain milestones and would be obligated to pay royalties at percentage rates that range from the mid-teens to the mid-twenties on sales of the Product in the U.S. for the Dialysis Indication. To date, VFMCRP has not Payments received for regulatory milestones and sales milestones are non-refundable. The regulatory milestones are payable if and when VFMCRP obtains approval from certain regulatory authorities and will be recognized as revenue in the period in which the associated milestone is achieved, assuming all other revenue recognition criteria are met. We account for the sales milestones as royalties and sales milestones payments will be recognized as revenue in the period in which the associated milestone is achieved or sales occur, assuming all other revenue recognition criteria are met. Pfizer Inc. In December 2014, May 2020, January 1, 2020 ( three In June 2023, 2022, 50 2023 2022 On October 21, 2019, 3 12 Under the terms of the Restated Pfizer Agreement we received non-refundable and non-creditable upfront payments of $295.0 million and are eligible to receive up to an additional $275.0 million upon the achievement of certain regulatory milestones. Pfizer received the exclusive license to commercialize Somatrogon worldwide. In addition, we are eligible to receive regional, tiered gross profit sharing for both Somatrogon and Pfizer’s Genotropin® (somatropin) in all global markets, with the U.S. region commencing gross profit sharing in August 2023. The Restated Pfizer Agreement will remain in effect until the last sale of the licensed product, unless earlier terminated in accordance with its terms. In addition to termination rights for material breach and bankruptcy, Pfizer is permitted to terminate the Restated Pfizer Agreement in its entirety, or with respect to one We recognized the non-refundable $295.0 million upfront payments as revenue as the research and development services were completed. As of September 30, 2024 December 31, 2023 The Restated Pfizer Agreement includes milestone payments of $275.0 million upon the achievement of certain milestones. The milestones range from $20.0 million to $90.0 million each and are based on achievement of regulatory approval in the U.S. and regulatory approval and price approval in other major markets. The milestone payments will be recognized as revenue in the period in which the associated milestone is achieved, assuming all other revenue recognition criteria are met. To date, $175.0 million of revenue has been recognized related to the achievement of the milestones. Other We have completed strategic deals with numerous institutions and commercial partners. In connection with these agreements, upon the achievement of certain milestones we are obligated to make certain payments and have royalty obligations upon sales of products developed under the license agreements. At this time, we are unable to estimate the timing and amounts of payments as the obligations are based on future development of the licensed products.

Note 15 - Segments

Note 15 - Segments	9 Months Ended
Note 15 - Segments	Sep. 30, 2024
Notes to Financial Statements
Segment Reporting Disclosure [Text Block]	NOTE 15 We manage our operations in two Rayaldee Information regarding our operations and assets for our operating segments and the unallocated corporate operations as well as geographic information are as follows: For the three months ended September 30, For the nine months ended September 30, (In thousands) 2024 2023 2024 2023 Revenue from services: Pharmaceutical $ — $ — $ — $ — Diagnostics 121,271 131,679 377,557 391,100 Corporate — — — — $ 121,271 $ 131,679 $ 377,557 $ 391,100 Revenue from products: Pharmaceutical $ 39,143 $ 40,670 $ 117,675 $ 124,553 Diagnostics — — — — Corporate — — — — $ 39,143 $ 40,670 $ 117,675 $ 124,553 Revenue from transfer of intellectual property and other: Pharmaceutical $ 13,218 $ 6,246 $ 34,272 $ 165,938 Diagnostics — — — — Corporate — — — — $ 13,218 $ 6,246 $ 34,272 $ 165,938 Operating income (loss): Pharmaceutical $ (32,196 ) $ (25,375 ) $ (84,697 ) $ 57,210 Diagnostics 58,541 (29,081 ) (2,443 ) (113,344 ) Corporate (12,129 ) (9,951 ) (31,786 ) (31,841 ) $ 14,216 $ (64,407 ) $ (118,926 ) $ (87,975 ) Depreciation and amortization: Pharmaceutical $ 18,043 $ 17,807 $ 53,899 $ 53,649 Diagnostics 6,120 8,376 20,238 25,666 Corporate — — — — $ 24,163 $ 26,183 $ 74,137 $ 79,315 Loss from investment in investees: Pharmaceutical $ (3 ) $ (20 ) $ (7 ) $ (99 ) Diagnostics — — — — Corporate — — — — $ (3 ) $ (20 ) $ (7 ) $ (99 ) Revenues: United States $ 132,663 $ 139,043 $ 410,422 $ 462,987 Ireland 11,514 8,654 30,579 121,249 Chile 16,576 16,932 49,067 52,427 Spain 6,297 4,349 17,828 16,427 Israel 196 3,155 797 9,388 Mexico 5,630 5,897 18,621 17,447 Other 756 565 2,190 1,666 $ 173,632 $ 178,595 $ 529,504 $ 681,591 September 30, December 31, (In thousands) 2024 2023 Assets: Pharmaceutical $ 1,271,781 $ 1,331,764 Diagnostics 517,871 630,753 Corporate 466,451 49,181 $ 2,256,103 $ 2,011,698 Goodwill: Pharmaceutical $ 316,161 $ 315,235 Diagnostics 219,707 283,025 $ 535,868 $ 598,260 No customer represented more than 10% nine September 30, 2024 2023 September 30, 2024 December 31, 2023 10%

Note 16 - Leases

Note 16 - Leases	9 Months Ended
Note 16 - Leases	Sep. 30, 2024
Notes to Financial Statements
Lessee, Leases [Text Block]	NOTE 16 We have operating leases for office space, laboratory operations, research and development facilities, manufacturing locations, warehouses and certain equipment. We determine if a contract contains a lease at inception or modification of a contract. Our leases generally do not January 1, 2019 not We elected the use of permitted practical expedients of not 12 not On January 2, 2023, October 2023. two five October 2033. The following table presents the lease balances within the Condensed Consolidated Balance Sheet as of September 30, 2024 December 31, 2023 (in thousands) Classification on the Balance Sheet September 30, 2024 December 31, 2023 Assets Operating lease assets Operating lease right-of-use assets $ 62,812 $ 68,088 Finance lease assets Property, plant and equipment, net 6,544 10,101 Liabilities Current Operating lease liabilities Current maturities of operating leases 12,741 12,996 Accrued expenses Current maturities of finance leases 1,855 2,827 Long-term Operating lease liabilities Operating lease liabilities 52,057 54,140 Other long-term liabilities Finance lease liabilities $ 4,689 $ 7,274 Weighted average remaining lease term Operating leases (in years) 6.3 7.1 Finance leases (in years) 7.1 6.2 Weighted average discount rate Operating leases 5.3 % 5.4 % Finance leases 3.7 % 3.8 % The following table reconciles the undiscounted future minimum lease payments (displayed by year and in the aggregate) under noncancelable operating leases with terms of more than one September 30, 2024 (in thousands) Operating Finance October 1, 2024 through December 31, 2024 $ 3,043 $ 673 2025 11,772 1,813 2026 10,937 1,334 2027 10,775 806 2028 10,785 203 Thereafter 26,534 1,959 Total undiscounted future minimum lease payments 73,846 6,788 Less: Difference between lease payments and discounted lease liabilities 9,048 244 Total lease liabilities $ 64,798 $ 6,544 Expense under operating leases and finance leases was $15.2 million and $2.5 million, respectively, for the nine September 30, 2024 nine September 30, 2023 not Supplemental cash flow information is as follows: For the nine months ended September 30, (in thousands) 2024 2023 Operating cash out flows from operating leases $ 15,101 $ 11,704 Operating cash out flows from finance leases 354 327 Financing cash out flows from finance leases 2,118 1,919 Total $ 17,573 $ 13,950

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended	9 Months Ended
Insider Trading Arrangements	Sep. 30, 2024	Sep. 30, 2024
Insider Trading Arr Line Items
Material Terms of Trading Arrangement [Text Block]		5. Other Information During the quarter ended September 30, 2024, none 10b5 1 10b5 1 408
Rule 10b5-1 Arrangement Adopted [Flag]	false
Non-Rule 10b5-1 Arrangement Adopted [Flag]	false
Rule 10b5-1 Arrangement Terminated [Flag]	false
Non-Rule 10b5-1 Arrangement Terminated [Flag]	false

Significant Accounting Policies

Significant Accounting Policies (Policies)	9 Months Ended
Significant Accounting Policies (Policies)	Sep. 30, 2024
Accounting Policies [Abstract]
Basis of Accounting, Policy [Policy Text Block]	Basis of presentation 10 10 X. not nine September 30, 2024 not may 2024 10 December 31, 2023
Consolidation, Policy [Policy Text Block]	Principles of consolidation
Use of Estimates, Policy [Policy Text Block]	Use of estimates
Cash and Cash Equivalents, Policy [Policy Text Block]	Cash, cash equivalents and restricted cash 90 90 The following table provides a reconciliation of cash, cash equivalents and restricted cash reported within the Condensed Consolidated Balance Sheet to the sum of such amounts in the Condensed Consolidated Statements of Cash Flows: September 30, 2024 December 31, 2023 Cash and cash equivalents $ 400,079 $ 95,881 Restricted cash, current 6,321 — Restricted cash, long-term 13,665 — Total cash, cash equivalents, and restricted cash shown in the Condensed Consolidated Statements of Cash Flows $ 420,065 $ 95,881 The Company classifies cash deposits related to letters of credit securing insurance and lease obligations as restricted cash, which is included in other assets, non-current, within the Consolidated Balance Sheet.
Inventory, Policy [Policy Text Block]	Inventories first first three nine September 30, 2024 three nine September 30, 2023
Goodwill and Intangible Assets, Policy [Policy Text Block]	Goodwill and intangible assets 5. September 30, 2024 December 31, 2023 Assets acquired and liabilities assumed in business combinations, licensing and other transactions are generally recognized at the date of acquisition at their respective fair values. Any excess of the purchase price over the estimated fair values of the net assets acquired is recognized as goodwill. At acquisition, we generally determine the fair value of intangible assets, including IPR&D, using the “income method.” Subsequent to their acquisition, goodwill and indefinite lived intangible assets are tested at least annually as of October 1 not may not Estimating the fair value of a reporting unit for goodwill impairment is highly sensitive to changes in projections and assumptions and changes in assumptions could potentially lead to impairment. We perform sensitivity analyses around our assumptions in order to assess the reasonableness of the assumptions and the results of our testing. Ultimately, potential changes in these assumptions may September 30, 2024 December 31, 2023 Net intangible assets other than goodwill were $836.4 million on each of September 30, 2024 December 31, 2023 may Upon regulatory approval, IPR&D assets are classified as finite-lived intangible assets. These assets are then amortized on a straight-line basis over their estimated useful lives. If a project is abandoned, the associated IPR&D costs are immediately expensed. We also regularly assess finite-lived intangible assets for impairment. This assessment involves comparing the carrying amount of an asset, which is its cost minus accumulated amortization, to its estimated future undiscounted cash flows. If the carrying amount exceeds the estimated future cash flows, an impairment charge is recognized to reflect the difference between the asset's carrying amount and its fair value. While we believe our estimates and assumptions used in impairment testing (including for goodwill and IPR&D) are reasonable and reflect those used by market participants, there is a potential risk of material impairment charges. Based on the current financial performance of our diagnostics segment and our Ireland reporting unit (which includes Eirgen and Rayaldee September 30, 2024 December 31, 2023 We amortize intangible assets with definite lives on a straight-line basis over their estimated useful lives, ranging from 3 to 20 years. We use the straight-line method of amortization as there is no three nine September 30, 2024 three nine September 30, 2023
Fair Value Measurement, Policy [Policy Text Block]	Fair value measurements September 30, 2024 December 31, 2023 In evaluating the fair value information, considerable judgment is required to interpret the market data used to develop the estimates. The use of different market assumptions and/or different valuation techniques may may not 9.
Business Combinations Policy [Policy Text Block]	Contingent consideration may may
Derivatives, Policy [Policy Text Block]	Derivative financial instruments September 30, 2024 December 31, 2023 not 10. 2029 144A 7 7. 9.
Property, Plant and Equipment, Policy [Policy Text Block]	Property, plant and equipment three nine September 30, 2024 three nine September 30, 2023
Impairment or Disposal of Long-Lived Assets, Policy [Policy Text Block]	Impairment of long-lived assets. may not
Income Tax, Policy [Policy Text Block]	Income taxes. not not We operate in various countries and tax jurisdictions globally. For interim reporting purposes, we record income taxes based on the expected effective income tax rate, taking into consideration year to date and global forecasted tax results. For the nine September 30, 2024 not Included in Other long-term liabilities is an accrual of $9.9 million related to uncertain tax positions involving income recognition. In connection with an examination of foreign tax returns for the 2015 2021 no
Revenue from Contract with Customer [Policy Text Block]	Revenue recognition 606, Revenue from Contracts with Customers 606” five We apply the five 606, 13.
Concentration Risk, Credit Risk, Policy [Policy Text Block]	Concentration of credit risk and allowance for credit losses While we have receivables due from federal and state governmental agencies, such receivables are not September 30, 2024 December 31, 2023 September 30, 2024 December 31, 2023 We assess the collectability of accounts receivable balances by considering factors such as historical collection experience, customer credit worthiness, the age of accounts receivable balances, regulatory changes and current economic conditions and trends that may September 30, 2024 December 31, 2023 three nine September 30, 2024 three nine September 30, 2023 As of September 30, 2024 14 December 31, 2023, 13, 14,
Stockholders' Equity, Policy [Policy Text Block]	Stock Repurchase Program. July 18, 2024, may 10b5 1 not no may three September 30, 2024.
Compensation Related Costs, Policy [Policy Text Block]	Equity-based compensation three nine September 30, 2024 three nine September 30, 2023
Research and Development Expense, Policy [Policy Text Block]	Research and development expenses third third Research and development expense includes costs for in-process research and development projects acquired in asset acquisitions which have not no
Segment Reporting, Policy [Policy Text Block]	Segment reporting two Rayaldee no no 15.
Shipping and Handling Costs [Policy Text Block]	Shipping and handling costs. not
Foreign Currency Transactions and Translations Policy [Policy Text Block]	Foreign currency translation three nine September 30, 2024 three nine September 30, 2023
Consolidation, Variable Interest Entity, Policy [Policy Text Block]	Variable interest entities 6.
Investment, Policy [Policy Text Block]	Investments 6. not 6.
New Accounting Pronouncements, Policy [Policy Text Block]	Accounting standards yet to be adopted. In December 2023, No. 2023 09, 740 2023 09” 2023 09 December 15, 2024. not 2023 09 In November 2023, No 2023 07, 280 2023 07” 2023 07 280. 280 December 15, 2024 Recently adopted accounting standards In 2021, two 15% December 15, 2022, 15%. 2024 2025. no 2024,

Note 3 - Summary of Significa_2

Note 3 - Summary of Significant Accounting Policies (Tables)	9 Months Ended
	Sep. 30, 2024
Notes Tables
Schedule of Cash and Cash Equivalents [Table Text Block]	September 30, 2024 December 31, 2023 Cash and cash equivalents $ 400,079 $ 95,881 Restricted cash, current 6,321 — Restricted cash, long-term 13,665 — Total cash, cash equivalents, and restricted cash shown in the Condensed Consolidated Statements of Cash Flows $ 420,065 $ 95,881

Note 4 - Earnings (Loss) Per _2

Note 4 - Earnings (Loss) Per Share (Tables)	9 Months Ended
Note 4 - Earnings (Loss) Per Share (Tables)	Sep. 30, 2024
Notes Tables
Schedule of Earnings Per Share, Basic and Diluted [Table Text Block]	For the three months ended September 30, For the nine months ended September 30, (In thousands, except per share data) 2024 2023 2024 2023 Numerator Net income (loss), basic $ 24,890 $ (84,473 ) $ (67,251 ) $ (122,380 ) Add: Interest on 2025 Notes 1 - - - Add: Interest on 2029 Convertible Notes 6,858 - - - Add: Loss on buy back of 2029 Convertible Notes 32 - - - Net income (loss), diluted $ 31,781 $ (84,473 ) $ (67,251 ) $ (122,380 ) Denominator (Shares in thousands) Weighted average common shares outstanding, basic 694,622,466 751,525,007 699,675,944 751,716,692 Effect of dilutive securities: Stock options 76,922 - - - Warrants - - - - 2025 Notes 48,295 - - - 2023 Convertible Notes - - - - 2033 Senior Notes 8,489 - - - 2029 Convertible Notes 303,607,464 Dilutive potential shares 303,741,170 - - - Weighted average common shares outstanding, diluted 998,363,636 751,525,007 699,675,944 751,716,692 Loss per share, basic $ 0.04 $ (0.11 ) $ (0.10 ) $ (0.16 ) Loss per share, diluted $ 0.03 $ (0.11 ) $ (0.10 ) $ (0.16 )

Note 5 - Composition of Certa_2

Note 5 - Composition of Certain Financial Statement Captions (Tables)	9 Months Ended
	Sep. 30, 2024
Notes Tables
Condensed Balance Sheet [Table Text Block]	September 30, December 31, (In thousands) 2024 2023 Accounts receivable, net: Accounts receivable $ 108,583 $ 125,379 Less: allowance for credit losses (2,004 ) (2,000 ) $ 106,579 $ 123,379 Inventories, net: Consumable supplies $ 16,218 $ 25,864 Finished products 34,206 35,582 Work in-process 2,265 1,731 Raw materials 10,491 8,981 Less: inventory reserve (3,772 ) (6,461 ) $ 59,408 $ 65,697 Other current assets and prepaid expenses: Escrow receivable $ 23,750 $ — Taxes recoverable 6,767 4,211 Prepaid expenses 9,572 6,177 Prepaid insurance 6,302 3,848 Other receivables 1,563 2,610 Other 9,295 7,673 $ 57,249 $ 24,519 Intangible assets, net: Customer relationships $ 258,048 $ 315,799 Technologies 818,971 831,509 Trade names 49,759 49,758 Covenants not to compete 12,917 12,916 Licenses 6,311 6,205 Product registrations 6,738 6,790 Other 6,052 6,000 Less: accumulated amortization (517,400 ) (488,694 ) $ 641,396 $ 740,283 Accrued expenses: Employee benefits and severance $ 38,474 $ 28,952 Clinical trials 3,725 7,624 Commitments and contingencies 11,141 8,088 Accrued interest 6,021 2,601 Gross to net provision 6,033 9,420 Inventory received but not invoiced 2,306 1,653 Finance leases short-term 1,855 2,827 Professional fees 4,375 3,470 Taxes payable 15,334 1,384 Royalties 767 1,544 Commissions 1,521 1,822 Other 31,254 20,701 $ 122,806 $ 90,086 Other long-term liabilities: Employee severance $ 16,284 $ — Mortgages and other debts payable 3,529 7,709 Finance leases long-term 4,689 7,274 Contract liabilities 7 7 Other 11,995 12,199 $ 36,504 $ 27,189
Schedule of Goodwill [Table Text Block]	2024 (In thousands) Gross goodwill at January 1, 2024 Cumulative impairment at January 1 Acquisitions, dispositions and other Foreign exchange and other Balance at September 30, 2024 Pharmaceuticals CURNA $ 4,827 $ (4,827 ) $ — $ — $ — Rayaldee 84,273 — — 925 85,198 FineTech 11,698 (11,698 ) — — — ModeX 80,260 — — — 80,260 OPKO Biologics 139,784 — — (0 ) 139,784 OPKO Chile 3,642 — — (81 ) 3,561 OPKO Health Europe 7,276 — — 82 7,358 OPKO Mexico 100 (100 ) — — — Transition Therapeutics 3,421 (3,421 ) — — — Diagnostics BioReference 283,025 — (63,318 ) — 219,707 OPKO Diagnostics 17,977 (17,977 ) — — — $ 636,283 $ (38,023 ) $ (63,318 ) $ 926 $ 535,868

Note 6 - Investments (Tables)

Note 6 - Investments (Tables)	9 Months Ended
Note 6 - Investments (Tables)	Sep. 30, 2024
Notes Tables
Investment [Table Text Block]	(in thousands) As of September 30, 2024 As of December 31, 2023 Investment type Investment Carrying Value Underlying Equity in Net Assets Investment Carrying Value Underlying Equity in Net Assets Equity method investments $ (0 ) $ 1,782 $ (0 ) $ 2,942 Variable interest entity, equity method 790 — 796 420 Equity method investments - FV option 92,166 9,786 Equity securities 130 116 Equity securities with no readily determinable fair value 7,521 5,382 Warrants and options 2 2 Total carrying value of investments $ 100,609 $ 16,082
Unrealized Gain (Loss) on Investments [Table Text Block]	For the nine months ended September 30, (in thousands) 2024 2023 Equity Securities: Net gains and losses recognized during the period on equity securities $ 43 $ (411 ) Less: Net gains and losses realized during the period on equity securities (30 ) — Unrealized net losses recognized during the period on equity securities still held at the reporting date $ 13 $ (411 )

Note 7 - Debt (Tables)

Note 7 - Debt (Tables)	9 Months Ended
Note 7 - Debt (Tables)	Sep. 30, 2024
Notes Tables
Schedule of Debt [Table Text Block]	September 30, December 31, (In thousands) 2024 2023 2029 Convertible Notes $ 178,645 $ — 2025 Notes 170 143,250 2033 Senior Notes 50 50 2023 Convertible Notes — 71,025 2044 Notes 245,358 — JPMorgan Chase Bank line of credit — 12,671 Chilean and Spanish lines of credit 11,713 12,629 Current portion of notes payable 1,509 1,993 Long term portion of notes payable 3,529 7,727 Total $ 440,974 $ 249,345 Balance sheet captions Current portion of convertible notes $ 170 $ — Long term portion of convertible notes 178,695 214,325 Current portion of lines of credit and notes payable 13,222 27,293 Long Term notes payable included in long-term liabilities 248,887 7,727 Total $ 440,974 $ 249,345
Long-Term Debt [Text Block]	(In thousands) 2029 convertible notes Embedded conversion option Discount Debt Issuance costs Total Balance at December 31, 2023 $ — $ — $ — $ — $ — Issuance of 3.75 301,054 125,620 (125,620 ) (8,562 ) 292,492 Amortization of debt discount and debt issuance costs — — 12,585 1,236 13,821 Change in fair value of embedded derivative — 26,250 — — 26,250 Reclassification of embedded derivative to equity — (151,870 ) — — (151,870 ) Repurchase (3,500 ) — 1,338 114 (2,048 ) Balance at September 30, 2024 $ 297,554 $ — $ (111,697 ) $ (7,212 ) $ 178,645
Schedule of Line of Credit Facilities [Table Text Block]	(Dollars in thousands) Balance Outstanding Interest rate on borrowings at Credit line September 30, December 31, Lender September 30, 2024 capacity 2024 2023 JPMorgan Chase 0.00 % $ — $ — $ 12,671 Itau Bank 5.50 % 1,900 469 1,264 Bank of Chile 6.60 % 2,500 711 1,728 BICE Bank 5.50 % 2,500 2,433 1,734 Scotiabank 5.00 % 5,500 3,060 981 Santander Bank 5.50 % 5,000 1,742 450 Security Bank 5.50 % 1,400 — — Estado Bank 5.50 % 4,000 1,355 3,303 BCI Bank 5.00 % 2,500 346 1,626 Internacional Bank 5.50 % 1,597 1,597 1,197 Consorcio Bank 5.00 % 2,000 — 346 Banco De Sabadell 1.75 % 558 — — Santander Bank 5.36 % 558 — — Total $ 30,013 $ 11,713 $ 25,300
Schedule of Long-Term Debt Instruments [Table Text Block]	September 30, December 31, (In thousands) 2024 2023 Current portion of notes payable $ 1,509 $ 1,993 Other long-term liabilities 3,529 7,727 Total $ 5,038 $ 9,720

Note 8 - Accumulated Other Co_2

Note 8 - Accumulated Other Comprehensive Loss (Tables)	9 Months Ended
Note 8 - Accumulated Other Comprehensive Loss (Tables)	Sep. 30, 2024
Notes Tables
Schedule of Accumulated Other Comprehensive Income (Loss) [Table Text Block]	Foreign currency (In thousands) translation Balance at December 31, 2023 $ (38,030 ) Other comprehensive loss (1,585 ) Balance at September 30, 2024 $ (39,615 )

Note 9 - Fair Value Measureme_2

Note 9 - Fair Value Measurements (Tables)	9 Months Ended
Note 9 - Fair Value Measurements (Tables)	Sep. 30, 2024
Notes Tables
Schedule of Fair Value, Assets and Liabilities Measured on Recurring Basis [Table Text Block]	Fair value measurements as of September 30, 2024 Quoted prices in active Significant markets for other Significant identical observable unobservable assets inputs inputs (In thousands) (Level 1) (Level 2) (Level 3) Total Assets: Money market funds $ 354,537 $ — $ — $ 354,537 Equity securities 130 — — 130 Equity Method - Fair value option 92,166 — — 92,166 Common stock options — 2 — 2 Total assets $ 446,833 $ 2 $ — $ 446,835 Fair value measurements as of December 31, 2023 Quoted prices in active Significant markets for other Significant identical observable unobservable assets inputs inputs (In thousands) (Level 1) (Level 2) (Level 3) Total Assets: Money market funds $ 32,404 $ — $ — $ 32,404 Equity securities 116 — — $ 116 Equity Method - fair value option 9,786 — — 9,786 Common stock options/warrants — 2 — 2 Total assets $ 42,306 $ 2 $ — $ 42,308 Liabilities: Forward contracts — 29 — 29 Total liabilities $ — $ 29 $ — $ 29
Fair Value, by Balance Sheet Grouping [Table Text Block]	September 30, 2024 Carrying Total (In thousands) Value Fair Value Level 1 Level 2 Level 3 2029 Convertible Notes $ 178,645 $ 396,652 $ — $ 396,652 $ — 2025 Notes $ 170 $ 170 $ — $ 170 $ —
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation [Table Text Block]	September 30, 2024 Embedded conversion (In thousands) option Balance at December 31, 2023 $ — Additions 125,620 Change in fair value: Included in results of operations 26,250 Reclassification of embedded derivatives to equity (151,870 ) Balance at September 30, 2024 $ —

Note 10 - Derivative Contracts

Note 10 - Derivative Contracts (Tables)	9 Months Ended
Note 10 - Derivative Contracts (Tables)	Sep. 30, 2024
Notes Tables
Schedule of Derivative Instruments in Statement of Financial Position, Fair Value [Table Text Block]	Balance Sheet September 30, December 31, (In thousands) Component 2024 2023 Derivative financial instruments: Common Stock options/warrants Investments, net $ 2 $ 2 Forward contracts Unrealized losses on forward contracts are recorded in Accrued expenses. $ — $ (29 )
Derivative Instruments, Gain (Loss) [Table Text Block]	Three months ended September 30, Nine months ended September 30, (In thousands) 2024 2023 2024 2023 Derivative gain (loss): Notes $ — $ — $ (26,250 ) $ — Common Stock options/warrants (1 ) (37 ) 1 (27 ) Forward contracts — 125 88 (802 ) Total $ (1 ) $ 88 $ (26,161 ) $ (829 )

Note 13 - Revenue Recognition (

Note 13 - Revenue Recognition (Tables)	9 Months Ended
Note 13 - Revenue Recognition (Tables)	Sep. 30, 2024
Notes Tables
Disaggregation of Revenue [Table Text Block]	Three months ended September 30, Nine months ended September 30, (In thousands) 2024 2023 2024 2023 Healthcare insurers $ 76,184 $ 81,469 $ 229,600 $ 238,934 Government payers 20,368 19,909 63,561 61,250 Client payers 20,773 25,906 71,521 77,973 Patients 3,946 4,395 12,875 12,943 Total $ 121,271 $ 131,679 $ 377,557 $ 391,100
Schedule of Product Sales Allowances and Accruals [Table Text Block]	(In thousands) Chargebacks, discounts, rebates and fees Governmental Returns Total Balance at June 30, 2024 $ 2,743 $ 5,991 $ 2,194 $ 10,928 Provision related to current period sales 4,005 5,776 317 10,098 Credits or payments made (5,058 ) (7,013 ) (278 ) (12,349 ) Balance at September 30, 2024 $ 1,690 $ 4,754 $ 2,233 $ 8,677 Total gross Rayaldee sales $ 15,865 Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales 64 % (In thousands) Chargebacks, discounts, rebates and fees Governmental Returns Total Balance at December 31, 2023 $ 2,578 $ 6,150 $ 2,192 $ 10,920 Provision related to current period sales 12,224 16,325 989 29,538 Credits or payments made (13,112 ) (17,721 ) (948 ) (31,781 ) Balance at September 30, 2024 $ 1,690 $ 4,754 $ 2,233 $ 8,677 Total gross Rayaldee sales $ 49,447 Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales 60 % (In thousands) Chargebacks, discounts, rebates and fees Governmental Returns Total Balance at June 30, 2023 $ 2,330 $ 5,954 $ 1,634 $ 9,918 Provision related to current period sales 3,446 4,998 322 8,766 Credits or payments made (4,125 ) (4,207 ) (15 ) (8,347 ) Balance at September 30, 2023 $ 1,651 $ 6,745 $ 1,941 $ 10,337 Total gross Rayaldee sales $ 16,090 Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales 54 % (In thousands) Chargebacks, discounts, rebates and fees Governmental Returns Total Balance at December 31, 2022 $ 1,532 $ 5,063 $ 1,683 $ 8,278 Provision related to current period sales 10,702 14,604 959 26,265 Credits or payments made (10,583 ) (12,922 ) (701 ) (24,206 ) Balance at September 30, 2023 $ 1,651 $ 6,745 $ 1,941 $ 10,337 Total gross Rayaldee sales $ 47,940 Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales 55 %

Note 15 - Segments (Tables)

Note 15 - Segments (Tables)	9 Months Ended
Note 15 - Segments (Tables)	Sep. 30, 2024
Notes Tables
Schedule of Segment Reporting Information, by Segment [Table Text Block]	For the three months ended September 30, For the nine months ended September 30, (In thousands) 2024 2023 2024 2023 Revenue from services: Pharmaceutical $ — $ — $ — $ — Diagnostics 121,271 131,679 377,557 391,100 Corporate — — — — $ 121,271 $ 131,679 $ 377,557 $ 391,100 Revenue from products: Pharmaceutical $ 39,143 $ 40,670 $ 117,675 $ 124,553 Diagnostics — — — — Corporate — — — — $ 39,143 $ 40,670 $ 117,675 $ 124,553 Revenue from transfer of intellectual property and other: Pharmaceutical $ 13,218 $ 6,246 $ 34,272 $ 165,938 Diagnostics — — — — Corporate — — — — $ 13,218 $ 6,246 $ 34,272 $ 165,938 Operating income (loss): Pharmaceutical $ (32,196 ) $ (25,375 ) $ (84,697 ) $ 57,210 Diagnostics 58,541 (29,081 ) (2,443 ) (113,344 ) Corporate (12,129 ) (9,951 ) (31,786 ) (31,841 ) $ 14,216 $ (64,407 ) $ (118,926 ) $ (87,975 ) Depreciation and amortization: Pharmaceutical $ 18,043 $ 17,807 $ 53,899 $ 53,649 Diagnostics 6,120 8,376 20,238 25,666 Corporate — — — — $ 24,163 $ 26,183 $ 74,137 $ 79,315 Loss from investment in investees: Pharmaceutical $ (3 ) $ (20 ) $ (7 ) $ (99 ) Diagnostics — — — — Corporate — — — — $ (3 ) $ (20 ) $ (7 ) $ (99 ) Revenues: United States $ 132,663 $ 139,043 $ 410,422 $ 462,987 Ireland 11,514 8,654 30,579 121,249 Chile 16,576 16,932 49,067 52,427 Spain 6,297 4,349 17,828 16,427 Israel 196 3,155 797 9,388 Mexico 5,630 5,897 18,621 17,447 Other 756 565 2,190 1,666 $ 173,632 $ 178,595 $ 529,504 $ 681,591
Reconciliation of Assets from Segment to Consolidated [Table Text Block]	September 30, December 31, (In thousands) 2024 2023 Assets: Pharmaceutical $ 1,271,781 $ 1,331,764 Diagnostics 517,871 630,753 Corporate 466,451 49,181 $ 2,256,103 $ 2,011,698 Goodwill: Pharmaceutical $ 316,161 $ 315,235 Diagnostics 219,707 283,025 $ 535,868 $ 598,260

Note 16 - Leases (Tables)

Note 16 - Leases (Tables)	9 Months Ended
Note 16 - Leases (Tables)	Sep. 30, 2024
Notes Tables
Assets and Liabilities, Lessee [Table Text Block]	(in thousands) Classification on the Balance Sheet September 30, 2024 December 31, 2023 Assets Operating lease assets Operating lease right-of-use assets $ 62,812 $ 68,088 Finance lease assets Property, plant and equipment, net 6,544 10,101 Liabilities Current Operating lease liabilities Current maturities of operating leases 12,741 12,996 Accrued expenses Current maturities of finance leases 1,855 2,827 Long-term Operating lease liabilities Operating lease liabilities 52,057 54,140 Other long-term liabilities Finance lease liabilities $ 4,689 $ 7,274 Weighted average remaining lease term Operating leases (in years) 6.3 7.1 Finance leases (in years) 7.1 6.2 Weighted average discount rate Operating leases 5.3 % 5.4 % Finance leases 3.7 % 3.8 %
Lessee, Lease Liability, Maturity [Table Text Block]	(in thousands) Operating Finance October 1, 2024 through December 31, 2024 $ 3,043 $ 673 2025 11,772 1,813 2026 10,937 1,334 2027 10,775 806 2028 10,785 203 Thereafter 26,534 1,959 Total undiscounted future minimum lease payments 73,846 6,788 Less: Difference between lease payments and discounted lease liabilities 9,048 244 Total lease liabilities $ 64,798 $ 6,544
Schedule of Supplemental Cash Flow Information of Leases [Table Text Block]	For the nine months ended September 30, (in thousands) 2024 2023 Operating cash out flows from operating leases $ 15,101 $ 11,704 Operating cash out flows from finance leases 354 327 Financing cash out flows from finance leases 2,118 1,919 Total $ 17,573 $ 13,950

Note 1 - Business and Organiz_2

Note 1 - Business and Organization (Details Textual) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Mar. 28, 2024	Dec. 31, 2023
Escrow Deposit	$ 23,750		$ 23,750			$ 0
Disposal Group, Not Discontinued Operation, Gain (Loss) on Disposal	121,493	$ 0	121,493	$ 0
Disposal Group, Held-for-Sale or Disposed of by Sale, Not Discontinued Operations [Member] \| Select Assets of BioReference [Member] \| Labcorp [Member]
Disposal Group, Including Discontinued Operation, Consideration					$ 237,500
Escrow Deposit					$ 23,700
Disposal Group, Not Discontinued Operation, Gain (Loss) on Disposal	$ 121,500		$ 121,500

Note 2 - Foreign Exchange Rat_2

Note 2 - Foreign Exchange Rates (Details Textual) $ in Millions	9 Months Ended
	Sep. 30, 2024 USD ($)	Sep. 30, 2023	Dec. 31, 2023 USD ($)
Accumulated Other Comprehensive Income (Loss), Foreign Currency Translation Adjustment, Net of Tax	$ 36.2		$ 34.6
Foreign Exchange Forward [Member]
Derivative, Number of Instruments Held	0		52
Derivative, Notional Amount			$ 2.9
Currency Concentration Risk [Member] \| Revenue Benchmark [Member] \| Other Currency [Member]
Concentration Risk, Percentage	22.30%	30.70%

Note 3 - Summary of Significa_3

Note 3 - Summary of Significant Accounting Policies (Details Textual) $ in Thousands		3 Months Ended		9 Months Ended		12 Months Ended
	Jan. 09, 2024 USD ($)	Sep. 30, 2024 USD ($) shares	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Dec. 31, 2023 USD ($)	Jul. 18, 2024 USD ($)
Inventory Write-down		$ 600	$ 2,600	$ 1,600	$ 4,000
Business Combination, Recognized Identifiable Assets Acquired and Liabilities Assumed, Goodwill and Intangible Assets		1,400,000		1,400,000		$ 1,500,000
Goodwill		535,868		535,868		598,260
Indefinite-Lived Intangible Assets (Excluding Goodwill)		836,400		836,400		836,400
Amortization of Intangible Assets		20,433	21,534	62,290	64,543
Depreciation		3,700	4,800	$ 11,900	14,800
Effective Income Tax Rate Reconciliation, at Federal Statutory Income Tax Rate, Percent				21%
Unrecognized Tax Benefits, Income Tax Penalties and Interest Accrued		9,900		$ 9,900
Open Tax Year				2015 2016 2017 2018 2019 2020 2021
Accounts Receivable, Allowance for Credit Loss, Current		2,004		$ 2,004		2,000
Accounts Receivable, Credit Loss Expense (Reversal)		(75,200)	98,300	67,500	183,400
Stock Repurchased During Period, Value	$ 50,000	23,759		73,759
Share-Based Payment Arrangement, Noncash Expense		2,800	3,200	$ 7,983	8,746
Number of Reportable Segments				2
Gain (Loss), Foreign Currency Transaction, before Tax		$ 4,100	$ (3,800)	$ 100	$ (1,900)
Repurchase of Common Stock [Member]
Share Repurchase Program, Authorized, Amount							$ 100,000
Stock Repurchased During Period, Shares (in shares) \| shares		14,893,026
Stock Repurchased During Period, Value		$ 23,800
Government Contract, BARDA [Member]
Accounts Receivable, after Allowance for Credit Loss		$ 1,600		$ 1,600		$ 600
Customer Concentration Risk [Member] \| Accounts Receivable [Member] \| Medicare and Medicaid [Member]
Concentration Risk, Percentage				6.50%		6.70%
Customer Concentration Risk [Member] \| Accounts Receivable [Member] \| Individual Patients [Member]
Concentration Risk, Percentage				2.20%		2%
Israel Tax Authority [Member]
Income Tax Examination, Estimate of Possible Loss				$ 246,000
Software and Software Development Costs [Member]
Property, Plant and Equipment, Useful Life (Year)		3 years		3 years
Minimum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)		3 years		3 years
Minimum [Member] \| Machinery and Equipment [Member]
Property, Plant and Equipment, Useful Life (Year)		5 years		5 years
Minimum [Member] \| Furniture and Fixtures [Member]
Property, Plant and Equipment, Useful Life (Year)		5 years		5 years
Minimum [Member] \| Building and Building Improvements [Member]
Property, Plant and Equipment, Useful Life (Year)		10 years		10 years
Minimum [Member] \| Vehicles [Member]
Property, Plant and Equipment, Useful Life (Year)		3 years		3 years
Maximum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)		20 years		20 years
Maximum [Member] \| Machinery and Equipment [Member]
Property, Plant and Equipment, Useful Life (Year)		8 years		8 years
Maximum [Member] \| Furniture and Fixtures [Member]
Property, Plant and Equipment, Useful Life (Year)		12 years		12 years
Maximum [Member] \| Building and Building Improvements [Member]
Property, Plant and Equipment, Useful Life (Year)		40 years		40 years
Maximum [Member] \| Vehicles [Member]
Property, Plant and Equipment, Useful Life (Year)		5 years		5 years
IRELAND
Goodwill		$ 304,900		$ 304,900		$ 367,300
In Process Research and Development [Member]
Indefinite-Lived Intangible Assets (Excluding Goodwill)		$ 195,000		$ 195,000		$ 195,000

Note 3 - Summary of Significa_4

Note 3 - Summary of Significant Accounting Policies - Reconciliation of Cash (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Cash and cash equivalents	$ 400,079	$ 95,881
Restricted cash, current	6,321	0
Restricted cash, long-term	13,665	0
Total cash, cash equivalents, and restricted cash shown in the Condensed Consolidated Statements of Cash Flows	$ 420,065	$ 95,881

Note 4 - Earnings (Loss) Per _3

Note 4 - Earnings (Loss) Per Share (Details Textual) - shares	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Antidilutive Securities Excluded from Computation of Earnings Per Share, Amount (in shares)	0	83,074,689	286,281,585	82,368,398
Share-Based Compensation Arrangement by Share-Based Payment Award, Options, Exercises in Period (in shares)	0	18,750	0	18,750
Stock Issued During Period, Shares, Restricted Stock Award, Net of Forfeitures (in shares)	0	0	549,687	549,680
Shares Issued, Shares, Share-Based Payment Arrangement, after Forfeiture (in shares)	0	18,750	384,378	405,721

Note 4 - Earnings (Loss) Per _4

Note 4 - Earnings (Loss) Per Share - Schedule of Earnings (Loss) Per Share (Details) - USD ($) $ / shares in Units, $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Net income (loss), basic	$ 24,890	$ (84,473)	$ (67,251)	$ (122,380)
Add: Loss on buy back of 2029 Convertible Notes	32	0	0	0
Net income (loss), diluted	$ 31,781	$ (84,473)	$ (67,251)	$ (122,380)
Weighted average common shares outstanding, basic (in shares)	694,622,466	751,525,007	699,675,944	751,716,692
Stock options (in shares)	76,922	0	0	0
Warrants (in shares)	0	0	0	0
Dilutive potential shares (in shares)	303,741,170	0	0	0
Weighted average common shares outstanding, diluted (in shares)	998,363,636	751,525,007	699,675,944	751,716,692
Loss per share, basic (in dollars per share)	$ 0.04	$ (0.11)	$ (0.1)	$ (0.16)
Loss per share, diluted (in dollars per share)	$ 0.03	$ (0.11)	$ (0.1)	$ (0.16)
The 2025 Notes [Member]
Add: Interest on Notes	$ 1	$ 0	$ 0	$ 0
Notes (in shares)	48,295	0	0	0
The 2029 Convertible Notes [Member]
Add: Interest on Notes	$ 6,858	$ 0	$ 0	$ 0
Notes (in shares)	303,607,464
The 2023 Convertible Notes [Member]
Notes (in shares)	0	0	0	0
The 2033 Senior Notes [Member]
Notes (in shares)	8,489	0	0	0

Note 5 - Composition of Certa_3

Note 5 - Composition of Certain Financial Statement Captions (Details Textual)	Sep. 30, 2024
Minimum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	3 years
Maximum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	20 years
Developed Technology Rights [Member] \| Minimum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	7 years
Developed Technology Rights [Member] \| Maximum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	17 years
Customer Relationships [Member] \| Minimum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	5 years
Customer Relationships [Member] \| Maximum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	20 years
Project Registration [Member] \| Minimum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	7 years
Project Registration [Member] \| Maximum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	10 years
Noncompete Agreements [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	5 years
Trade Names [Member] \| Minimum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	5 years
Trade Names [Member] \| Maximum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	10 years
Other Intangible Assets [Member] \| Minimum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	9 years
Other Intangible Assets [Member] \| Maximum [Member]
Finite-Lived Intangible Asset, Useful Life (Year)	13 years

Note 5 - Composition of Certa_4

Note 5 - Composition of Certain Financial Statement Captions - Schedule of Financial Statement Information (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Accounts receivable	$ 108,583	$ 125,379
Less: allowance for credit losses	(2,004)	(2,000)
Accounts Receivable, after Allowance for Credit Loss, Current	106,579	123,379
Consumable supplies	16,218	25,864
Finished products	34,206	35,582
Work in-process	2,265	1,731
Raw materials	10,491	8,981
Less: inventory reserve	(3,772)	(6,461)
Inventory, Net	59,408	65,697
Escrow receivable	23,750	0
Taxes recoverable	6,767	4,211
Prepaid expenses	9,572	6,177
Prepaid insurance	6,302	3,848
Other receivables	1,563	2,610
Other	9,295	7,673
Prepaid Expense and Other Assets, Current	57,249	24,519
Less: accumulated amortization	(517,400)	(488,694)
Finite-Lived Intangible Assets, Net	641,396	740,283
Employee benefits and severance	38,474	28,952
Clinical trials	3,725	7,624
Commitments and contingencies	11,141	8,088
Accrued interest	6,021	2,601
Gross to net provision	6,033	9,420
Inventory received but not invoiced	2,306	1,653
Finance leases short-term	1,855	2,827
Professional fees	4,375	3,470
Taxes payable	15,334	1,384
Royalties	767	1,544
Commissions	1,521	1,822
Other	31,254	20,701
Accrued Liabilities, Current	122,806	90,086
Employee severance	16,284	0
Mortgages and other debts payable	3,529	7,709
Finance leases long-term	4,689	7,274
Contract liabilities	7	7
Other	11,995	12,199
Other Liabilities, Noncurrent	36,504	27,189
Customer Relationships [Member]
Finite lived intangible assets, gross	258,048	315,799
Technology-Based Intangible Assets [Member]
Finite lived intangible assets, gross	818,971	831,509
Trade Names [Member]
Finite lived intangible assets, gross	49,759	49,758
Noncompete Agreements [Member]
Finite lived intangible assets, gross	12,917	12,916
Licensing Agreements [Member]
Finite lived intangible assets, gross	6,311	6,205
Project Registration [Member]
Finite lived intangible assets, gross	6,738	6,790
Other Intangible Assets [Member]
Finite lived intangible assets, gross	$ 6,052	$ 6,000

Note 5 - Composition of Certa_5

Note 5 - Composition of Certain Financial Statement Captions - Schedule of Goodwill (Details) $ in Thousands	9 Months Ended
	Sep. 30, 2024 USD ($)
Goodwill, gross	$ 636,283
Goodwill, impairment	(38,023)
Goodwill, acquired (disposed of)	(63,318)
Goodwill, foreign exchange effect	926
Goodwill	535,868
Pharmaceutical [Member] \| CURNA [Member]
Goodwill, gross	4,827
Goodwill, impairment	(4,827)
Goodwill, acquired (disposed of)	0
Goodwill, foreign exchange effect	0
Goodwill	0
Pharmaceutical [Member] \| Rayaldee [Member]
Goodwill, gross	84,273
Goodwill, impairment	0
Goodwill, acquired (disposed of)	0
Goodwill, foreign exchange effect	925
Goodwill	85,198
Pharmaceutical [Member] \| FineTech [Member]
Goodwill, gross	11,698
Goodwill, impairment	(11,698)
Goodwill, acquired (disposed of)	0
Goodwill, foreign exchange effect	0
Goodwill	0
Pharmaceutical [Member] \| ModeX Therapeutics, Inc [Member]
Goodwill, gross	80,260
Goodwill, impairment	0
Goodwill, acquired (disposed of)	0
Goodwill, foreign exchange effect	0
Goodwill	80,260
Pharmaceutical [Member] \| OPKO Biologics [Member]
Goodwill, gross	139,784
Goodwill, impairment	0
Goodwill, acquired (disposed of)	0
Goodwill, foreign exchange effect	0
Goodwill	139,784
Pharmaceutical [Member] \| OPKO Chile [Member]
Goodwill, gross	3,642
Goodwill, impairment	0
Goodwill, acquired (disposed of)	0
Goodwill, foreign exchange effect	(81)
Goodwill	3,561
Pharmaceutical [Member] \| OPKO Health Europe [Member]
Goodwill, gross	7,276
Goodwill, impairment	0
Goodwill, acquired (disposed of)	0
Goodwill, foreign exchange effect	82
Goodwill	7,358
Pharmaceutical [Member] \| OPKO Mexico [Member]
Goodwill, gross	100
Goodwill, impairment	(100)
Goodwill, acquired (disposed of)	0
Goodwill, foreign exchange effect	0
Goodwill	0
Pharmaceutical [Member] \| Transition Therapeutics [Member]
Goodwill, gross	3,421
Goodwill, impairment	(3,421)
Goodwill, acquired (disposed of)	0
Goodwill, foreign exchange effect	0
Goodwill	0
Diagnostics [Member] \| BioReference [Member]
Goodwill, gross	283,025
Goodwill, impairment	0
Goodwill, acquired (disposed of)	(63,318)
Goodwill, foreign exchange effect	0
Goodwill	219,707
Diagnostics [Member] \| OPKO Diagnostics [Member]
Goodwill, gross	17,977
Goodwill, impairment	(17,977)
Goodwill, acquired (disposed of)	0
Goodwill, foreign exchange effect	0
Goodwill	$ 0

Note 6 - Investments (Details T

Note 6 - Investments (Details Textual) - USD ($) $ in Thousands	1 Months Ended	3 Months Ended			9 Months Ended		12 Months Ended
	Sep. 30, 2021	Sep. 30, 2024	Dec. 31, 2023	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023	Jun. 30, 2024
Assets		$ 2,256,103	$ 2,011,698		$ 2,256,103		$ 2,011,698
Liabilities		852,686	622,479		852,686		622,479
Equity Method Investment, Quoted Market Value		600	700		600		700
Proceeds from Sale of Equity Securities, FV-NI					46,731	$ 364
Income (Loss) from Equity Method Investments		(3)		$ (20)	(7)	(99)
Revenue from Contract with Customer, Excluding Assessed Tax		173,632		178,595	529,504	681,591
LeaderMed [Member] \| LeaderMed Joint Venture [Member]
Minority Interest, Shares Issued (in shares)	4,703
Subsidiary, Ownership Percentage, Parent	47%
Revenue from Contract with Customer, Excluding Assessed Tax	$ 1,000
Equity Method Investment, Nonconsolidated Investee or Group of Investees [Member]
Assets		66,100	85,500		66,100		85,500
Liabilities		$ 23,300	$ 20,800		23,300		20,800
Net Income (Loss), Including Portion Attributable to Noncontrolling Interest					$ (27,700)		$ (37,700)
Pharmsynthez [Member]
Equity Method Investment, Ownership Percentage		6%			6%
COCP [Member]
Equity Method Investment, Ownership Percentage		2%			2%
NIMS [Member]
Equity Method Investment, Ownership Percentage		1%			1%
BioCardia [Member]
Equity Method Investment, Ownership Percentage		1%			1%
Class of Warrant or Right, Number of Securities Called by Warrants or Rights (in shares)		47,000			47,000
Xenetic [Member]
Equity Method Investment, Ownership Percentage		3%			3%
Zebra [Member]
Equity Method Investment, Ownership Percentage		29%			29%
Zebra [Member] \| Variable Interest Entity, Not Primary Beneficiary [Member]
Equity Method Investment, Ownership Percentage		29%	29%		29%		29%
Zebra [Member] \| Variable Interest Entity, Not Primary Beneficiary [Member] \| Series A-2 Preferred Stock [Member]
Investment Owned, Balance, Shares (in shares)		1,260,000	1,260,000		1,260,000		1,260,000
Zebra [Member] \| Variable Interest Entity, Not Primary Beneficiary [Member] \| Restricted Stock [Member]
Investment Owned, Balance, Shares (in shares)		900,000	900,000		900,000		900,000
LeaderMed [Member]
Equity Method Investment, Ownership Percentage		47%			47%
Neovasc [Member]
Equity Method Investment, Ownership Percentage		0.50%			0.50%
Proceeds from Sale of Equity Method Investments			$ 363				$ 363
GeneDx Holdings [Member]
Equity Method Investment, Ownership Percentage		8.10%			8.10%			13.61%
Equity Method Investment, Quoted Market Value		$ 92,200			$ 92,200
Investment Owned, Shares Sold (in shares)		1,386,929
Proceeds from Sale of Equity Securities, FV-NI		$ 46,700
Business Acquisition, Outstanding Shares Held, Percentage		5%			5%
Income (Loss) from Equity Method Investments		$ 35,400		$ (8,300)	$ 118,600	$ (19,900)
VBI Vaccines Inc. [Member]
Income (Loss) from Equity Method Investments		$ (30)
Equity Ownership, Excluding Consolidated Entity and Equity Method Investee, Percentage		0%			0%
ChromaDex Corporation [Member]
Equity Method Investment, Ownership Percentage		0.05%			0.05%
Equity Ownership, Excluding Consolidated Entity and Equity Method Investee, Percentage		0.05%			0.05%
Eloxx Pharmaceuticals, Inc. [Member]
Equity Method Investment, Ownership Percentage		1%			1%
Equity Ownership, Excluding Consolidated Entity and Equity Method Investee, Percentage		1%			1%
CAMP4 [Member]
Equity Ownership, Excluding Consolidated Entity and Equity Method Investee, Percentage		2%			2%
HealthSnap, Inc. [Member]
Equity Ownership, Excluding Consolidated Entity and Equity Method Investee, Percentage		4%			4%
InCellDx [Member]
Equity Method Investment, Ownership Percentage			29%				29%
Class of Warrant or Right, Number of Securities Called by Warrants or Rights (in shares)			700,000				700,000

Note 6 - Investments - Schedule

Note 6 - Investments - Schedule of Investments (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Equity method investments	$ 0	$ 0
Equity method investments, underlying value	1,782	2,942
Variable interest entity, equity method	790	796
Variable interest entity, equity method	0	420
Equity method investments - FV option	92,166	9,786
Equity securities	130	116
Equity securities with no readily determinable fair value	7,521	5,382
Warrants and options	2	2
Investments	$ 100,609	$ 16,082

Note 6 - Investments - Gains an

Note 6 - Investments - Gains and Losses on Equity Securities (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Net gains and losses recognized during the period on equity securities	$ 43	$ (411)
Less: Net gains and losses realized during the period on equity securities	(30)	0
Unrealized net losses recognized during the period on equity securities still held at the reporting date	$ 13	$ (411)

Note 7 - Debt (Details Textual)

Note 7 - Debt (Details Textual)							1 Months Ended		3 Months Ended			9 Months Ended		47 Months Ended
Note 7 - Debt (Details Textual)	Sep. 16, 2024 USD ($)	Jul. 17, 2024 USD ($)	Apr. 01, 2024 USD ($)	Jan. 09, 2024 USD ($) $ / shares	Feb. 10, 2023 $ / shares	Feb. 01, 2019 USD ($)	May 31, 2021 USD ($) shares	Feb. 28, 2018 USD ($) $ / shares	Sep. 30, 2024 USD ($)	Mar. 31, 2024 USD ($)	Mar. 28, 2024 USD ($)	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)	Dec. 31, 2016 USD ($)	Jul. 17, 2029	Dec. 31, 2023 USD ($)	Jan. 31, 2023 USD ($)	Feb. 28, 2019 USD ($)	Nov. 30, 2015 USD ($)	Jan. 31, 2013
Proceeds from Convertible Debt												$ 230,000,000	$ 0
Stock Repurchased During Period, Value				$ 50,000,000					$ 23,759,000			73,759,000
Shares Acquired, Average Cost Per Share (in dollars per share) \| $ / shares				$ 0.9067
Repayments of Convertible Debt												4,881,000	0
Long-Term Debt									440,974,000			440,974,000				$ 249,345,000
Line of Credit Facility, Maximum Borrowing Capacity									$ 30,013,000			30,013,000
Repayments of Lines of Credit												$ 465,301,000	$ 519,597,000
Conversion of the 2025 Notes into Common Stock [Member]
Debt Conversion, Original Debt, Amount							$ 55,400,000
Debt Conversion, Converted Instrument, Shares Issued (in shares) \| shares							19,051,270
Line of Credit [Member]
Debt, Weighted Average Interest Rate									5.40%			5.40%				7.50%
Minimum [Member]
Long-Term Debt, Percentage Bearing Variable Interest, Percentage Rate									0.70%			0.70%
Maximum [Member]
Long-Term Debt, Percentage Bearing Variable Interest, Percentage Rate									4.50%			4.50%
The 2044 Notes [Member]
Debt Instrument, Face Amount		$ 250,000,000
Debt Instrument, Basis Spread on Variable Rate		7.50%
Debt Instrument, Repayment Fee, Percent		3%
Debt Instrument, Early Extinguishment, Percent of Principal Amount		150%
Debt Instrument, Repayment Fee, Royalty Percentage		80%
Debt Instrument, Additional Authorized Amount		$ 50,000,000
Long-Term Debt									$ 245,358,000			$ 245,358,000				$ 0
The 2044 Notes [Member] \| Forecast [Member]
Debt Instrument, Early Extinguishment, Percent of Principal Amount															200%
The 2044 Notes [Member] \| Minimum [Member]
Debt Instrument, Basis Spread on Variable Rate		4%
The 2029 Convertible Notes 1 [Member]
Debt Instrument, Face Amount				$ 230,000,000
Debt Instrument, Interest Rate, Stated Percentage				3.75%
Proceeds from Convertible Debt				$ 222,000,000
Debt Instrument, Repurchase Amount									3,500,000			3,500,000
Embedded Derivative, Fair Value of Embedded Derivative Liability				$ 125,600,000
Embedded Derivative, Gain (Loss) on Embedded Derivative, Net											$ 26,250,000
Embedded Derivative, No Longer Bifurcated, Amount Reclassified to Stockholders' Equity			$ 151,900,000
Debt Instrument, Convertible, Conversion Ratio				869.5652
Debt Instrument, Convertible, Conversion Price (in dollars per share) \| $ / shares				$ 1.15
Debt Instrument, Sinking Fund Payment				$ 0
Debt Instrument, Redemption Price, Percentage				100%
Repayments of Convertible Debt									4,800,000
Gain (Loss) on Repurchase of Debt Instrument									32,000
Write-off of Unamortized Discount									1,300,000
Deferred Debt Issuance Cost, Writeoff									100,000
The 2029 Convertible Notes 1 [Member] \| Convertible Debt [Member]
Proceeds from Issuance of Debt				$ 146,300,000
The 2029 Convertible Notes 1 [Member] \| Debt Instrument, Redemption, Period One [Member]
Debt Instrument, Convertible, Threshold Trading Days				20
Debt Instrument, Convertible, Threshold Consecutive Trading Days				30
Debt Instrument, Convertible, Threshold Percentage of Stock Price Trigger				130%
The 2029 Convertible Notes 1 [Member] \| Debt Instrument, Redemption, Period Two [Member]
Debt Instrument, Convertible, Threshold Trading Days				5
Debt Instrument, Convertible, Threshold Consecutive Trading Days				10
Debt Instrument, Convertible, Threshold Percentage of Stock Price Trigger				98%
The 2029 Convertible Notes 1 [Member] \| Scenario, Event of Default [Member]
Debt Instrument, Redemption Price, Percentage				100%
Debt Instrument, Ownership Interest				25%
The 2029 Convertible Affiliate Notes [Member]
Debt Instrument, Face Amount				$ 71,100,000
Debt Instrument, Interest Rate, Stated Percentage				3.75%
The 2029 Convertible Affiliate Notes [Member] \| Convertible Debt [Member]
Debt Instrument, Face Amount				$ 71,100,000
The 2023 Convertible Notes [Member]
Debt Instrument, Repurchase Amount				55,000,000
Interest Payable				16,100,000
Convertible Debt				0
Long-Term Debt									0			0				71,025,000
The 2023 Convertible Notes [Member] \| Convertible Debt [Member]
Debt Instrument, Face Amount				55,000,000				$ 55,000,000
Debt Instrument, Interest Rate, Stated Percentage								5%
Interest Payable				16,100,000
Debt Instrument, Convertible, Conversion Price (in dollars per share) \| $ / shares								$ 5
Debt Instrument, Term (Year)								5 years
Debt Instrument, Convertible, Conversion Premium, Percent					25%
Debt Instrument, Convertible, Conversion Premium, Per Share (in dollars per share) \| $ / shares					$ 1.66
The 2025 Notes [Member] \| Convertible Debt [Member]
Debt Instrument, Face Amount				170,000
Debt Instrument, Repurchase Amount				$ 144,400,000
The 2025 Notes [Member] \| Debt Instrument, Redemption, Period One [Member] \| Convertible Debt [Member]
Debt Instrument, Convertible, Threshold Consecutive Trading Days						30
The 2025 Notes [Member] \| Scenario, Event of Default [Member] \| Convertible Debt [Member]
Debt Instrument, Face Amount																		$ 200,000,000
Debt Instrument, Interest Rate, Stated Percentage																		4.50%
The 2033 Senior Notes [Member]
Long-Term Debt									$ 50,000			$ 50,000				50,000
The 2033 Senior Notes [Member] \| Convertible Debt [Member]
Debt Instrument, Repurchase Amount						$ 28,800,000
Debt Conversion, Converted Instrument, Amount														$ 143,200,000
Repayments of Debt										$ 3,000,000
Long-Term Debt										$ 50,600
The 2033 Senior Notes [Member] \| Senior Notes [Member]
Debt Instrument, Face Amount																	$ 175,000,000
Debt Instrument, Interest Rate, Stated Percentage																				3%
Credit Agreement [Member] \| Line of Credit [Member] \| Revolving Credit Facility [Member]
Line of Credit Facility, Maximum Borrowing Capacity																			$ 50,000,000
Repayments of Lines of Credit	$ 9,700,000
Long-Term Line of Credit, Noncurrent																$ 12,700,000
Credit Agreement [Member] \| Line of Credit [Member] \| Bridge Loan [Member]
Line of Credit Facility, Maximum Borrowing Capacity																			20,000,000
Credit Agreement [Member] \| Line of Credit [Member] \| Letter of Credit [Member]
Line of Credit Facility, Maximum Borrowing Capacity																			$ 20,000,000
Notes and Other Debt [Member]
Debt, Weighted Average Interest Rate									1.80%			1.80%				2.90%

Note 7 - Debt - Schedule of Deb

Note 7 - Debt - Schedule of Debt (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Long-term debt	$ 440,974	$ 249,345
Current portion of notes payable	1,509	1,993
Long term portion of notes payable	3,529	7,727
Convertible Notes [Member]
Current portion of notes payable	170	0
Long term portion of notes payable	178,695	214,325
Line Of Credit And Notes And Loans Payable Current Member
Long-term debt	13,222	27,293
Other Noncurrent Liabilities [Member]
Long-term debt	248,887	7,727
The 2029 Convertible Notes [Member]
Long-term debt	178,645	0
The 2025 Convertible Notes [Member]
Long-term debt	170	143,250
The 2033 Senior Notes [Member]
Long-term debt	50	50
The 2023 Convertible Notes [Member]
Long-term debt	0	71,025
The 2044 Notes [Member]
Long-term debt	245,358	0
J P Morgan Chase [Member]
Long-term debt	0	12,671
Chilean and Spanish Lines of Credit [Member]
Long-term debt	$ 11,713	$ 12,629

Note 7 - Debt - Schedule of Lon

Note 7 - Debt - Schedule of Long-term Debt (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Balance, total	$ 249,345
Issuance of 3.75% 2029 convertible notes, debt issuance cost	(13,385)	$ 0
Amortization of debt issuance cost	1,328	$ 908
Balance, total	440,974
The 2029 Convertible 144A Notes [Member]
Balance	0
Balance, embedded conversion option	0
Balance, discount	0
Balance, debt issuance cost	0
Balance, total	0
Issuance of 3.75% 2029 Convertible Notes	301,054
Issuance of 3.75% 2029 convertible notes, embedded conversion option	125,620
Issuance of 3.75% 2029 convertible notes, discount	(125,620)
Issuance of 3.75% 2029 convertible notes, debt issuance cost	(8,562)
Issuance of 3.75% 2029 convertible notes, total	292,492
Amortization of debt discount	12,585
Amortization of debt issuance cost	1,236
Amortization of debt discount and debt issuance costs, total	13,821
Change in fair value of embedded derivative	26,250
Change in fair value of embedded derivative, total	26,250
Reclassification of embedded derivative to equity	(151,870)
Repurchase	(3,500)
Repurchase	1,338
Repurchase	114
Repurchase	(2,048)
Balance	297,554
Balance, embedded conversion option	0
Balance, discount	(111,697)
Balance, debt issuance cost	(7,212)
Balance, total	$ 178,645

Note 7 - Debt - Schedule of L_2

Note 7 - Debt - Schedule of Long-term Debt (Details) (Parentheticals)	Sep. 30, 2024
The 2029 Convertible 144A Notes [Member]
Interest rate, convertible notes	3.75%

Note 7 - Debt - Schedule of Lin

Note 7 - Debt - Schedule of Line of Credit Facilities (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Interest rate
Credit line capacity	$ 30,013
Line of credit	$ 11,713	$ 25,300
J P Morgan Chase [Member]
Interest rate	0%
Credit line capacity	$ 0
Line of credit	$ 0	12,671
Itau Bank [Member]
Interest rate	5.50%
Credit line capacity	$ 1,900
Line of credit	$ 469	1,264
Bank of Chile [Member]
Interest rate	6.60%
Credit line capacity	$ 2,500
Line of credit	$ 711	1,728
BICE Bank [Member]
Interest rate	5.50%
Credit line capacity	$ 2,500
Line of credit	$ 2,433	1,734
Scotiabank [Member]
Interest rate	5%
Credit line capacity	$ 5,500
Line of credit	$ 3,060	981
Santander Bank [Member]
Interest rate	5.50%
Credit line capacity	$ 5,000
Line of credit	$ 1,742	450
Security Bank [Member]
Interest rate	5.50%
Credit line capacity	$ 1,400
Line of credit	$ 0	0
Estado Bank [Member]
Interest rate	5.50%
Credit line capacity	$ 4,000
Line of credit	$ 1,355	3,303
BCI Bank [Member]
Interest rate	5%
Credit line capacity	$ 2,500
Line of credit	$ 346	1,626
Internacional Bank [Member]
Interest rate	5.50%
Credit line capacity	$ 1,597
Line of credit	$ 1,597	1,197
Consorcio Bank [Member]
Interest rate	5%
Credit line capacity	$ 2,000
Line of credit	$ 0	346
Banco De Sabadell [Member]
Interest rate	1.75%
Credit line capacity	$ 558
Line of credit	$ 0	0
Santander Bank 2 [Member]
Interest rate	5.36%
Credit line capacity	$ 558
Line of credit	$ 0	$ 0

Note 7 - Debt - Schedule of D_2

Note 7 - Debt - Schedule of Debt Instruments (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Current portion of notes payable	$ 1,509	$ 1,993
Other long-term liabilities	36,504	27,189
Total	440,974	249,345
Notes Payable And Other Long Term Liabilities [Member]
Current portion of notes payable	1,509	1,993
Other long-term liabilities	3,529	7,727
Total	$ 5,038	$ 9,720

Note 8 - Accumulated Other Co_3

Note 8 - Accumulated Other Comprehensive Loss - Changed in Accumulated Other Comprehensive Loss (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Balance at December 31, 2023	$ 1,395,317	$ 1,535,348	$ 1,389,219	$ 1,561,648
Other comprehensive loss	7,038	(9,553)	(1,584)	(3,172)
Balance at September 30, 2024	1,403,417	$ 1,444,568	1,403,417	$ 1,444,568
Accumulated Foreign Currency Adjustment Attributable to Parent [Member]
Balance at December 31, 2023			(38,030)
Other comprehensive loss			(1,585)
Balance at September 30, 2024	$ (39,615)		$ (39,615)

Note 9 - Fair Value Measureme_3

Note 9 - Fair Value Measurements - Financial Assets and Liabilities Measured on a Recurring Basis (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Equity Method - Fair value option	$ 92,166	$ 9,786
Fair Value, Recurring [Member]
Money market funds	354,537	32,404
Equity securities	130	116
Equity Method - Fair value option	92,166	9,786
Common stock options/warrants	2	2
Total assets	446,835	42,308
Forward contracts		29
Total liabilities		29
Fair Value, Recurring [Member] \| Fair Value, Inputs, Level 1 [Member]
Money market funds	354,537	32,404
Equity securities	130	116
Equity Method - Fair value option	92,166	9,786
Common stock options/warrants	0	0
Total assets	446,833	42,306
Forward contracts		0
Total liabilities		0
Fair Value, Recurring [Member] \| Fair Value, Inputs, Level 2 [Member]
Money market funds	0	0
Equity securities	0	0
Equity Method - Fair value option	0	0
Common stock options/warrants	2	2
Total assets	2	2
Forward contracts		29
Total liabilities		29
Fair Value, Recurring [Member] \| Fair Value, Inputs, Level 3 [Member]
Money market funds	0	0
Equity securities	0	0
Equity Method - Fair value option	0	0
Common stock options/warrants	0	0
Total assets	$ 0	0
Forward contracts		0
Total liabilities		$ 0

Note 9 - Fair Value Measureme_4

Note 9 - Fair Value Measurements - Carrying Value and Estimated Fair Value of Notes (Details) - Convertible Debt [Member] $ in Thousands	Sep. 30, 2024 USD ($)
The 2029 Convertible Notes 1 [Member] \| Reported Value Measurement [Member]
Notes	$ 178,645
The 2029 Convertible Notes 1 [Member] \| Estimate of Fair Value Measurement [Member]
Notes	396,652
The 2029 Convertible Notes 1 [Member] \| Estimate of Fair Value Measurement [Member] \| Fair Value, Inputs, Level 1 [Member]
Notes	0
The 2029 Convertible Notes 1 [Member] \| Estimate of Fair Value Measurement [Member] \| Fair Value, Inputs, Level 2 [Member]
Notes	396,652
The 2029 Convertible Notes 1 [Member] \| Estimate of Fair Value Measurement [Member] \| Fair Value, Inputs, Level 3 [Member]
Notes	0
The 2025 Convertible Notes [Member] \| Reported Value Measurement [Member]
Notes	170
The 2025 Convertible Notes [Member] \| Estimate of Fair Value Measurement [Member]
Notes	170
The 2025 Convertible Notes [Member] \| Estimate of Fair Value Measurement [Member] \| Fair Value, Inputs, Level 1 [Member]
Notes	0
The 2025 Convertible Notes [Member] \| Estimate of Fair Value Measurement [Member] \| Fair Value, Inputs, Level 2 [Member]
Notes	170
The 2025 Convertible Notes [Member] \| Estimate of Fair Value Measurement [Member] \| Fair Value, Inputs, Level 3 [Member]
Notes	$ 0

Note 9 - Fair Value Measureme_5

Note 9 - Fair Value Measurements - Reconciliation of Level 3 Instruments (Details) - Derivative Financial Instruments, Liabilities [Member] - Fair Value, Inputs, Level 3 [Member] $ in Thousands	9 Months Ended
	Sep. 30, 2024 USD ($)
Balance at December 31, 2023	$ 0
Additions	125,620
Included in results of operations	26,250
Reclassification of embedded derivatives to equity	(151,870)
Balance at September 30, 2024	$ 0

Note 10 - Derivative Contract_2

Note 10 - Derivative Contracts - Summary of Fair Values and Presentation of Derivatives Financial Instruments (Details) - Not Designated as Hedging Instrument [Member] - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Common Stock Options/ Warrants [Member] \| Investment, Net [Member]
Derivative financial instruments	$ 2	$ 2
Foreign Exchange Forward [Member] \| Accrued Expenses [Member]
Derivative financial instruments	$ 0	$ (29)

Note 10 - Derivative Contract_3

Note 10 - Derivative Contracts - Summary of Gains and Losses Recorded (Details) - Not Designated as Hedging Instrument [Member] - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Derivative gain (loss)	$ (1)	$ 88	$ (26,161)	$ (829)
Embedded Derivative Financial Instruments [Member] \| The 2029 Convertible Notes 1 [Member]
Derivative gain (loss)	0	0	(26,250)	0
Common Stock Options/ Warrants [Member]
Derivative gain (loss)	(1)	(37)	1	(27)
Foreign Exchange Forward [Member]
Derivative gain (loss)	$ 0	$ 125	$ 88	$ (802)

Note 11 - Related Party Trans_2

Note 11 - Related Party Transactions (Details Textual)			3 Months Ended				9 Months Ended		12 Months Ended
Note 11 - Related Party Transactions (Details Textual)	Jan. 09, 2024 USD ($)	May 04, 2023 USD ($)	Sep. 30, 2024 USD ($) shares	Mar. 31, 2024 USD ($)	Dec. 31, 2023 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2024 USD ($) shares	Sep. 30, 2023 USD ($)	Dec. 31, 2023 USD ($)	Aug. 01, 2024 USD ($) ft²	Jul. 31, 2024 a	Jun. 30, 2024	Feb. 28, 2018 USD ($)
Operating Expenses			$ 159,416,000			$ 243,002,000	$ 648,430,000	$ 769,566,000
Ruen-Hui Biopharmaceuticals, Inc. [Member]
Equity Method Investment, Ownership Percentage		10%
Ruen-Hui Biopharmaceuticals, Inc. [Member] \| License Agreement [Member]
Payments to Acquire Equity Method Investments		$ 150,000
Collaborative Arrangement, Maximum Regulatory Milestone Payments		$ 1,000,000
Pharmsynthez [Member]
Equity Method Investment, Ownership Percentage			6%				6%
Xenetic [Member]
Equity Method Investment, Ownership Percentage			3%				3%
Zebra [Member]
Equity Method Investment, Ownership Percentage			29%				29%
ChromaDex Corporation [Member]
Equity Method Investment, Ownership Percentage			0.05%				0.05%
COCP [Member]
Equity Method Investment, Ownership Percentage			2%				2%
NIMS [Member]
Equity Method Investment, Ownership Percentage			1%				1%
Eloxx Pharmaceuticals, Inc. [Member]
Equity Method Investment, Ownership Percentage			1%				1%
BioCardia [Member]
Equity Method Investment, Ownership Percentage			1%				1%
LeaderMed [Member]
Equity Method Investment, Ownership Percentage			47%				47%
Neovasc [Member]
Equity Method Investment, Ownership Percentage			0.50%				0.50%
Proceeds from Sale of Equity Method Investments					$ 363,000				$ 363,000
GeneDx Holdings [Member]
Equity Method Investment, Ownership Percentage			8.10%				8.10%					13.61%
InCellDx [Member]
Equity Method Investment, Ownership Percentage					29%				29%
The 2029 Convertible Notes 1 [Member]
Debt Instrument, Face Amount	$ 230,000,000
The 2029 Convertible Notes 1 [Member] \| Convertible Debt [Member]
Debt Instrument, Issued, Principal	71,100,000
The 2023 Convertible Notes [Member]
Interest Payable	16,100,000
The 2023 Convertible Notes [Member] \| Convertible Debt [Member]
Debt Instrument, Face Amount	55,000,000												$ 55,000,000
Interest Payable	$ 16,100,000
Frost Real Estate Holdings, LLC [Member]
Area of Real Estate Property (Acre)										26,328	29,500
Operating Leases, Monthly Payments, Year One										$ 91,000
Operating Leases, Monthly Payments, Year Five										$ 103,000
GeneDx [Member] \| Transition Services Agreement [Member]
Operating Expenses				$ 1,200,000
Accounts Receivable, after Allowance for Credit Loss			$ 0				$ 0
GeneDx [Member] \| Transition Services Agreement [Member] \| Services Rendered [Member]
Operating Expenses			$ 0				$ 0
Director [Member] \| Pharmsynthez [Member]
Investment Owned, Balance, Shares (in shares) \| shares			6				6
Director [Member] \| Xenetic [Member]
Investment Owned, Balance, Shares (in shares) \| shares			3				3
Beckman Coulter [Member]
Related Party Transaction, Amounts of Transaction							$ 2,600,000
Integrated DNA Technologies Inc. [Member]
Related Party Transaction, Amounts of Transaction							3,300,000
Leica Microsystems Inc. [Member]
Related Party Transaction, Amounts of Transaction							300,000
Executive Officer [Member] \| Reimbursement of Travel Expenses [Member]
Related Party Transaction, Amounts of Transaction			$ 0			$ 49,500	$ 23,900	$ 78,800

Note 12 - Commitments and Con_2

Note 12 - Commitments and Contingencies (Details Textual) - USD ($)			9 Months Ended
	Dec. 29, 2022	Jul. 14, 2022	Sep. 30, 2024
Purchase Obligation			$ 44,000,000
Settled Litigation [Member]
Litigation Settlement, Amount Awarded to Other Party		$ 10,000,000
Litigation Settlement, Interest Rate		1.50%
Settled Litigation [Member] \| UNITED STATES
Litigation Settlement, Amount Awarded to Other Party		$ 9,853,958
Settled Litigation [Member] \| Commonwealth [Member]
Litigation Settlement, Amount Awarded to Other Party		141,041
Settled Litigation [Member] \| CONNECTICUT
Litigation Settlement, Amount Awarded to Other Party		$ 5,001
Israel Tax Authority [Member]
Income Tax Examination, Estimate of Possible Loss			$ 246,000,000
Foreign Tax Jurisdiction [Member] \| Israel Tax Authority [Member] \| Tax Year 2014 Through Tax Year 2020 [Member]
Income Tax Examination, Estimate of Possible Loss	$ 246,000,000

Note 13 - Revenue Recognition_2

Note 13 - Revenue Recognition (Details Textual) - USD ($) $ in Thousands			1 Months Ended	3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 28, 2023	Mar. 08, 2023	Sep. 30, 2024	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023
Contract with Customer, Performance Obligation Satisfied in Previous Period						$ 2,200	$ 19,800
Accrued Expense, Payor Overpayment Reimbursement, Liability			$ 4,900	$ 4,900		4,900		$ 3,100
Revenue from Contract with Customer, Excluding Assessed Tax				173,632	$ 178,595	529,504	681,591
BARDA Agreement [Member]
Revenue from Contract with Customer, Excluding Assessed Tax			$ 24,100	5,500		12,800
Merck Agreement [Member] \| Merck Sharp & Dohme LLC [Member]
Revenue from Contract with Customer, Excluding Assessed Tax	$ 50,000	$ 50,000
Rayaldee [Member]
Contract with Customer, Liability, Revenue Recognized				5,800	7,300	19,900	21,700
Revenue from Contract with Customer, Excluding Assessed Tax				15,865	16,090	49,447	47,940
Transfer of Intellectual Property and Other [Member]
Revenue from Contract with Customer, Excluding Assessed Tax				13,218	6,246	34,272	165,938
Transfer of Intellectual Property and Other [Member] \| Milestone Payments [Member] \| Pfizer Inc. [Member]
Revenue from Contract with Customer, Excluding Assessed Tax				$ 7,000	$ 4,900	$ 18,900	$ 11,800
Transfer of Intellectual Property and Other [Member] \| Development and License Agreement [Member] \| Vifor Fresenius Medical Care Renal Pharma Ltd. [Member]
Revenue from Contract with Customer, Excluding Assessed Tax								7,000
Transfer of Intellectual Property and Other [Member] \| Development and License Agreement [Member] \| NICOYA Macau Limited [Member]
Revenue from Contract with Customer, Excluding Assessed Tax								$ 2,500

Note 13 - Revenue Recognition -

Note 13 - Revenue Recognition - Composition of Revenue From Services (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Revenue from Contract with Customer, Excluding Assessed Tax	$ 173,632	$ 178,595	$ 529,504	$ 681,591
Service [Member]
Revenue from Contract with Customer, Excluding Assessed Tax	121,271	131,679	377,557	391,100
Healthcare Insurers [Member] \| Service [Member]
Revenue from Contract with Customer, Excluding Assessed Tax	76,184	81,469	229,600	238,934
Government Payers [Member] \| Service [Member]
Revenue from Contract with Customer, Excluding Assessed Tax	20,368	19,909	63,561	61,250
Client Payers [Member] \| Service [Member]
Revenue from Contract with Customer, Excluding Assessed Tax	20,773	25,906	71,521	77,973
Self-Pay [Member] \| Service [Member]
Revenue from Contract with Customer, Excluding Assessed Tax	$ 3,946	$ 4,395	$ 12,875	$ 12,943

Note 13 - Revenue Recognition_3

Note 13 - Revenue Recognition - Analysis of Product Sales Allowances and Accruals (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended		12 Months Ended	15 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023	Sep. 30, 2024
Total gross Rayaldee sales	$ 173,632	$ 178,595	$ 529,504	$ 681,591
Rayaldee [Member]
Balance at beginning	10,928	9,918	10,920	8,278	$ 8,278	$ 9,918
Provision related to current period sales	10,098	8,766	29,538	26,265
Credits or payments made	(12,349)	(8,347)	(31,781)	(24,206)
Balance at end	8,677	10,337	8,677	10,337	10,920	8,677
Total gross Rayaldee sales	$ 15,865	$ 16,090	$ 49,447	$ 47,940
Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales	64%	54%	60%	55%
Chargebacks, Discounts, Rebates and Fees [Member] \| Rayaldee [Member]
Balance at beginning	$ 2,743	$ 2,330	$ 2,578	$ 1,532	1,532	2,330
Provision related to current period sales	4,005	3,446	12,224	10,702
Credits or payments made	(5,058)	(4,125)	(13,112)	(10,583)
Balance at end	1,690	1,651	1,690	1,651	2,578	1,690
Governmental [Member] \| Rayaldee [Member]
Balance at beginning	5,991	5,954	6,150	5,063	5,063	5,954
Provision related to current period sales	5,776	4,998	16,325	14,604
Credits or payments made	(7,013)	(4,207)	(17,721)	(12,922)
Balance at end	4,754	6,745	4,754	6,745	6,150	4,754
Sales Returns [Member] \| Rayaldee [Member]
Balance at beginning	2,194	1,634	2,192	1,683	1,683	1,634
Provision related to current period sales	317	322	989	959
Credits or payments made	(278)	(15)	(948)	(701)
Balance at end	$ 2,233	$ 1,941	$ 2,233	$ 1,941	$ 2,192	$ 2,233

Note 14 - Strategic Alliances (

Note 14 - Strategic Alliances (Details Textual) - USD ($) $ in Thousands							1 Months Ended	3 Months Ended			9 Months Ended		12 Months Ended		15 Months Ended	19 Months Ended
	Sep. 28, 2023	Mar. 08, 2023	Sep. 14, 2021	Jul. 06, 2021	Jun. 18, 2021	May 05, 2020	Sep. 30, 2024	Sep. 30, 2024	Sep. 30, 2023	Mar. 31, 2023	Sep. 30, 2024	Sep. 30, 2023	Dec. 31, 2023	Dec. 31, 2022	Sep. 30, 2024	Sep. 30, 2024	Jun. 30, 2024	Oct. 01, 2019
Revenue from Contract with Customer, Excluding Assessed Tax								$ 173,632	$ 178,595		$ 529,504	$ 681,591
CAMP4 [Member]
Subsidiary, Ownership Percentage, Noncontrolling Owner				9%
Corporate Joint Venture [Member] \| LeaderMed Joint Venture [Member]
Revenue from Contract with Customer, Excluding Assessed Tax			$ 1,000
Subsidiary, Ownership Percentage, Parent			47%
Corporate Joint Venture [Member] \| LeaderMed Joint Venture [Member] \| LeaderMed [Member]
Payments to Acquire Interest in Joint Venture			$ 11,000
Subsidiary, Ownership Percentage, Noncontrolling Owner			53%
CAMP4 [Member]
Revenue from Contract with Customer, Excluding Assessed Tax				$ 1,500
Collaborative Arrangement, Upfront Payment, Shares (in shares)				3,373,008
CAMP4 [Member] \| Dravet Syndrome Products [Member]
Collaborative Arrangement, Development Milestone Payment				$ 3,500
Collaborative Arrangement, Sales Milestone Payment				$ 90,000
Collaborative Arrangement, Development Milestone Payment, Shares (in shares)				5,782,299
CAMP4 [Member] \| Non-Dravet Syndrome Products [Member]
Collaborative Arrangement, Development Milestone Payment				$ 4,000
Collaborative Arrangement, Sales Milestone Payment				$ 90,000
Collaborative Arrangement, Development Milestone Payment, Shares (in shares)				1,082,248
BARDA Agreement [Member]
Collaborative Arrangement, Supplement for Advance of Development							$ 26,900	26,900			26,900				$ 26,900	$ 26,900
Revenue from Contract with Customer, Excluding Assessed Tax							24,100	5,500			12,800
Collaborative Arrangement, Value							110,000	110,000			110,000				110,000	110,000	$ 59,000
Collaborative Arrangement, Value, Including Milestones							205,000	205,000			205,000				205,000	205,000	$ 168,600
Aggregate Transaction Price Allocated to Remaining Performance Obligations, Excluding Unexercised Contract Options, Amount											96,000
Merck Agreement [Member] \| Merck Sharp & Dohme LLC [Member]
Revenue from Contract with Customer, Excluding Assessed Tax	$ 50,000	$ 50,000
Collaborative Arrangement, Development Milestone Payment		$ 872,500											$ 12,500
Collaborative Arrangement, Development Costs																24,500
Development and License Agreement [Member] \| NICOYA Macau Limited [Member] \| EirGen [Member]
Revenue from Contract with Customer, Excluding Assessed Tax					$ 5,000					$ 2,500
Collaborative Arrangement, Development Milestone Payment					115,000
Collaborative Agreement, Delayed Payment					$ 5,000
Collaborative Agreement, Delayed Payment Received, Cumulative										$ 2,500
Collaborative Arrangement, Period Following First Commercial Sale (Year)					10 years
Development and License Agreement [Member] \| Vifor Fresenius Medical Care Renal Pharma Ltd. [Member] \| EirGen [Member]
Revenue from Contract with Customer, Excluding Assessed Tax													7,000
Collaborative Arrangement, Sales Milestone Payment						$ 200,000
Collaborative Arrangement, Maximum Regulatory Milestone Payments						15,000
Collaborative Agreement, Option, Sales Milestone Payments						555,000
Development and License Agreement [Member] \| Vifor Fresenius Medical Care Renal Pharma Ltd. [Member] \| First Marketing Approval of Rayaldee in Europe [Member] \| EirGen [Member]
Revenue from Contract with Customer, Excluding Assessed Tax						3,000
Development and License Agreement [Member] \| Vifor Fresenius Medical Care Renal Pharma Ltd. [Member] \| Germany Price Approval by Local Sick Fund Association [Member] \| EirGen [Member]
Revenue from Contract with Customer, Excluding Assessed Tax						$ 7,000
Transfer of Intellectual Property and Other [Member] \| Vifor Fresenius Medical Care Renal Pharma Ltd. [Member] \| EirGen [Member]
Revenue from Contract with Customer, Excluding Assessed Tax														$ 3,000
Pfizer Agreement [Member] \| Pfizer Inc. [Member]
Revenue from Contract with Customer, Excluding Assessed Tax													90,000	$ 85,000	175,000
Collaborative Arrangement, Maximum Regulatory Milestone Payments																		$ 275,000
Revenue, Remaining Performance Obligation, Amount																		295,000
Contract with Customer, Liability							$ 0	$ 0			$ 0		$ 0		$ 0	$ 0
Pfizer Agreement [Member] \| Pfizer Inc. [Member] \| Minimum [Member]
Collaborative Agreements, Each Milestone Payment																		20,000
Pfizer Agreement [Member] \| Pfizer Inc. [Member] \| Maximum [Member]
Collaborative Agreements, Each Milestone Payment																		$ 90,000

Note 15 - Segments (Details Tex

Note 15 - Segments (Details Textual) $ in Thousands	9 Months Ended		12 Months Ended
Note 15 - Segments (Details Textual) $ in Thousands	Sep. 30, 2024 USD ($)	Sep. 30, 2023	Dec. 31, 2023
Number of Reportable Segments	2
Customer Concentration Risk [Member] \| Revenue from Contract with Customer Benchmark [Member]
Number of Major Customers	0	0
Customer Concentration Risk [Member] \| Accounts Receivable [Member]
Number of Major Customers	0		0
Intersegment Eliminations [Member]
Revenues	$ 0
Interest Expense	$ 0

Note 15 - Segments - Operations

Note 15 - Segments - Operations by Segment (Details) - USD ($) $ in Thousands	3 Months Ended		9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023	Sep. 30, 2024	Sep. 30, 2023
Revenue from Contract with Customer, Excluding Assessed Tax	$ 173,632	$ 178,595	$ 529,504	$ 681,591
Operating income (loss)	14,216	(64,407)	(118,926)	(87,975)
Depreciation and amortization	24,163	26,183	74,137	79,315
Loss from investment in investees	(3)	(20)	(7)	(99)
UNITED STATES
Revenue from Contract with Customer, Excluding Assessed Tax	132,663	139,043	410,422	462,987
IRELAND
Revenue from Contract with Customer, Excluding Assessed Tax	11,514	8,654	30,579	121,249
CHILE
Revenue from Contract with Customer, Excluding Assessed Tax	16,576	16,932	49,067	52,427
SPAIN
Revenue from Contract with Customer, Excluding Assessed Tax	6,297	4,349	17,828	16,427
ISRAEL
Revenue from Contract with Customer, Excluding Assessed Tax	196	3,155	797	9,388
MEXICO
Revenue from Contract with Customer, Excluding Assessed Tax	5,630	5,897	18,621	17,447
Other Countries [Member]
Revenue from Contract with Customer, Excluding Assessed Tax	756	565	2,190	1,666
Service [Member]
Revenue from Contract with Customer, Excluding Assessed Tax	121,271	131,679	377,557	391,100
Product [Member]
Revenue from Contract with Customer, Excluding Assessed Tax	39,143	40,670	117,675	124,553
Transfer of Intellectual Property and Other [Member]
Revenue from Contract with Customer, Excluding Assessed Tax	13,218	6,246	34,272	165,938
Operating Segments [Member] \| Pharmaceutical [Member]
Operating income (loss)	(32,196)	(25,375)	(84,697)	57,210
Depreciation and amortization	18,043	17,807	53,899	53,649
Loss from investment in investees	(3)	(20)	(7)	(99)
Operating Segments [Member] \| Pharmaceutical [Member] \| Service [Member]
Revenue from Contract with Customer, Excluding Assessed Tax	0	0	0	0
Operating Segments [Member] \| Pharmaceutical [Member] \| Product [Member]
Revenue from Contract with Customer, Excluding Assessed Tax	39,143	40,670	117,675	124,553
Operating Segments [Member] \| Pharmaceutical [Member] \| Transfer of Intellectual Property and Other [Member]
Revenue from Contract with Customer, Excluding Assessed Tax	13,218	6,246	34,272	165,938
Operating Segments [Member] \| Diagnostics [Member]
Operating income (loss)	58,541	(29,081)	(2,443)	(113,344)
Depreciation and amortization	6,120	8,376	20,238	25,666
Loss from investment in investees	0	0	0	0
Operating Segments [Member] \| Diagnostics [Member] \| Service [Member]
Revenue from Contract with Customer, Excluding Assessed Tax	121,271	131,679	377,557	391,100
Operating Segments [Member] \| Diagnostics [Member] \| Product [Member]
Revenue from Contract with Customer, Excluding Assessed Tax	0	0	0	0
Operating Segments [Member] \| Diagnostics [Member] \| Transfer of Intellectual Property and Other [Member]
Revenue from Contract with Customer, Excluding Assessed Tax	0	0	0	0
Segment Reporting, Reconciling Item, Corporate Nonsegment [Member]
Operating income (loss)	(12,129)	(9,951)	(31,786)	(31,841)
Depreciation and amortization	0	0	0	0
Loss from investment in investees	0	0	0	0
Segment Reporting, Reconciling Item, Corporate Nonsegment [Member] \| Service [Member]
Revenue from Contract with Customer, Excluding Assessed Tax	0	0	0	0
Segment Reporting, Reconciling Item, Corporate Nonsegment [Member] \| Product [Member]
Revenue from Contract with Customer, Excluding Assessed Tax	0	0	0	0
Segment Reporting, Reconciling Item, Corporate Nonsegment [Member] \| Transfer of Intellectual Property and Other [Member]
Revenue from Contract with Customer, Excluding Assessed Tax	$ 0	$ 0	$ 0	$ 0

Note 15 - Segments - Assets by

Note 15 - Segments - Assets by Segment (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Assets	$ 2,256,103	$ 2,011,698
Goodwill	535,868	598,260
Segment Reporting, Reconciling Item, Corporate Nonsegment [Member]
Assets	466,451	49,181
Pharmaceutical [Member] \| Operating Segments [Member]
Assets	1,271,781	1,331,764
Goodwill	316,161	315,235
Diagnostics [Member] \| Operating Segments [Member]
Assets	517,871	630,753
Goodwill	$ 219,707	$ 283,025

Note 16 - Leases (Details Textu

Note 16 - Leases (Details Textual)		9 Months Ended
Note 16 - Leases (Details Textual)	Jan. 02, 2023 USD ($) a	Sep. 30, 2024 USD ($)	Sep. 30, 2023 USD ($)
Operating Lease, Cost		$ 15,200,000	$ 12,000,000
Finance Lease, Interest Expense		2,500,000	2,200,000
Variable Lease, Cost		$ 1,500,000	$ 900,000
Office Space [Member] \| ModeX Therapeutics, Inc [Member]
Lessee, Operating Lease, Term of Contract (Year)	10 years
Area of Real Estate Property (Acre) \| a	33,056
Lessee, Operating Lease, Renewal Term (Year)	5 years
Operating Lease, Monthly Rent Expense	$ 243,500

Note 16 - Leases - Lease Balanc

Note 16 - Leases - Lease Balances (Details) - USD ($) $ in Thousands	Sep. 30, 2024	Dec. 31, 2023
Operating lease assets	$ 62,812	$ 68,088
Finance lease assets	6,544	10,101
Operating lease liabilities	12,741	12,996
Accrued expenses	1,855	2,827
Operating lease liabilities	52,057	54,140
Other long-term liabilities	$ 4,689	$ 7,274
Operating leases (in years) (Year)	6 years 3 months 18 days	7 years 1 month 6 days
Finance leases (in years) (Year)	7 years 1 month 6 days	6 years 2 months 12 days
Operating leases	5.30%	5.40%
Finance leases	3.70%	3.80%

Note 16 - Leases - Undiscounted

Note 16 - Leases - Undiscounted Future Minimum Lease Payments (Details) $ in Thousands	Sep. 30, 2024 USD ($)
April 1, 2024 through December 31, 2024, operating	$ 3,043
April 1, 2024 through December 31, 2024, finance	673
2025, operating	11,772
2025, finance	1,813
2026, operating	10,937
2026, finance	1,334
2027, operating	10,775
2027, finance	806
2028, operating	10,785
2028, finance	203
Thereafter, operating	26,534
Thereafter, finance	1,959
Total undiscounted future minimum lease payments, operating	73,846
Total undiscounted future minimum lease payments, finance	6,788
Less: Difference between lease payments and discounted lease liabilities, operating	9,048
Less: Difference between lease payments and discounted lease liabilities, finance	244
Total lease liabilities, operating	64,798
Total lease liabilities, finance	$ 6,544

Note 16 - Leases - Supplemental

Note 16 - Leases - Supplemental Cash Flow Information (Details) - USD ($) $ in Thousands	9 Months Ended
	Sep. 30, 2024	Sep. 30, 2023
Operating cash out flows from operating leases	$ 15,101	$ 11,704
Operating cash out flows from finance leases	354	327
Financing cash out flows from finance leases	2,118	1,919
Total	$ 17,573	$ 13,950