OPKO Health (OPK) 10-Q 7 Aug 19 2019 Q2 Quarterly report Financial data

COVER PAGE

COVER PAGE - shares	6 Months Ended
	Jun. 30, 2019	Jul. 30, 2019
Cover page.
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Jun. 30, 2019
Document Transition Report	false
Entity File Number	001-33528
Entity Registrant Name	OPKO Health, Inc.
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
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Emerging Growth Company	false
Entity Shell Company	false
Title of 12(b) Security	Common Stock
Trading Symbol	OPK
Security Exchange Name	NASDAQ
Entity Common Stock, Shares Outstanding (in shares)		615,601,045
Entity Central Index Key	0000944809
Amendment Flag	false
Document Fiscal Year Focus	2019
Document Fiscal Period Focus	Q2
Current Fiscal Year End Date	--12-31

CONDENSED CONSOLIDATED BALANE S

CONDENSED CONSOLIDATED BALANE SHEETS - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Current assets:
Cash and cash equivalents	$ 111,115	$ 96,473
Accounts receivable, net	148,287	143,907
Inventory, net	48,293	42,299
Other current assets and prepaid expenses	36,533	35,052
Total current assets	344,228	317,731
Property, plant and equipment, net	137,106	144,674
Intangible assets, net	581,306	614,452
In-process research and development	635,569	635,572
Goodwill	699,842	700,193
Investments	24,767	31,228
Operating lease right-of-use assets	29,640
Other assets	3,770	7,222
Total assets	2,456,228	2,451,072
Current liabilities:
Accounts payable	60,376	47,395
Accrued expenses	198,382	203,513
Current maturities of operating leases	13,376
Current portion of convertible notes	0	31,562
Current portion of lines of credit and notes payable	11,240	5,851
Total current liabilities	283,374	288,321
Operating lease liabilities	16,673
Convertible notes	206,165	57,299
Deferred tax liabilities, net	113,334	115,193
Other long-term liabilities, principally contract liabilities, contingent consideration and line of credit	127,751	198,968
Total long-term liabilities	463,923	371,460
Total liabilities	747,297	659,781
Equity:
Common Stock - $0.01 par value, 1,000,000,000 and 750,000,000 shares authorized at June 30, 2019 and December 31, 2018, respectively; 616,150,952 and 586,881,720 shares issued at June 30, 2019 and December 31, 2018, respectively	6,162	5,869
Treasury Stock - 549,907 and 549,907 shares at June 30, 2019 and December 31, 2018, respectively	(1,791)	(1,791)
Additional paid-in capital	3,061,631	3,004,422
Accumulated other comprehensive loss	(20,351)	(20,131)
Accumulated deficit	(1,336,720)	(1,197,078)
Total shareholders’ equity	1,708,931	1,791,291
Total liabilities and equity	$ 2,456,228	$ 2,451,072

CONDENSED CONSOLIDATED BALANE_2

CONDENSED CONSOLIDATED BALANE SHEETS (Parenthetical) - $ / shares	Jun. 30, 2019	Dec. 31, 2018
Statement of Financial Position [Abstract]
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	1,000,000,000	750,000,000
Common stock, shares issued (in shares)	616,150,952	586,881,720
Treasury stock, shares (in shares)	549,907	549,907

CONDENSED CONSOLIDATED STATEMEN

CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Revenues:
Total revenues	$ 226,368	$ 263,685	$ 448,820	$ 518,598
Costs and expenses:
Selling, general and administrative	88,475	87,653	183,633	179,172
Research and development	28,286	29,211	64,816	62,097
Contingent consideration	(3,775)	(15,358)	1,031	(13,599)
Amortization of intangible assets	16,419	17,227	32,981	34,498
Asset impairment charges	0	0	655	0
Total costs and expenses	273,628	268,793	571,397	566,317
Operating loss	(47,260)	(5,108)	(122,577)	(47,719)
Other income and (expense), net:
Interest income	572	27	1,127	67
Interest expense	(5,501)	(2,722)	(10,257)	(4,989)
Fair value changes of derivative instruments, net	(388)	2,248	27	3,644
Other income, net	(5,874)	8,584	(4,897)	10,477
Other income and (expense), net	(11,191)	8,137	(14,000)	9,199
Income (loss) before income taxes and investment losses	(58,451)	3,029	(136,577)	(38,520)
Income tax provision	(1,084)	(2,017)	(1,866)	(1,126)
Net income (loss) before investment losses	(59,535)	1,012	(138,443)	(39,646)
Loss from investments in investees	(271)	(7,213)	(2,125)	(9,669)
Net loss	$ (59,806)	$ (6,201)	$ (140,568)	$ (49,315)
Loss per share, basic and diluted:
Loss per share (in dollars per share)	$ (0.10)	$ (0.01)	$ (0.24)	$ (0.09)
Weighted average common shares outstanding, basic and diluted (in shares)	586,351,045	559,541,253	586,347,645	559,507,732
Services
Revenues:
Total revenues	$ 178,458	$ 216,055	$ 357,349	$ 427,369
Costs and expenses:
Cost of service revenue	130,078	134,408	259,981	273,849
Products
Revenues:
Total revenues	28,680	28,523	53,981	56,374
Costs and expenses:
Cost of service revenue	14,145	15,652	28,300	30,300
Revenue from transfer of intellectual property and other
Revenues:
Total revenues	$ 19,230	$ 19,107	$ 37,490	$ 34,855

CONDENSED CONSOLIDATED STATEM_2

CONDENSED CONSOLIDATED STATEMENTS OF COMPREHENSIVE LOSS - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Statement of Comprehensive Income [Abstract]
Net loss	$ (59,806)	$ (6,201)	$ (140,568)	$ (49,315)
Other comprehensive income (loss), net of tax:
Change in foreign currency translation and other comprehensive income (loss)	2,878	(12,465)	(220)	(7,600)
Investments:
Reclassification adjustment due to adoption of ASU 2016-01	0	0	0	(4,876)
Comprehensive loss	$ (56,928)	$ (18,666)	$ (140,788)	$ (61,791)

CONSOLIDATED STATEMENTS OF EQUI

CONSOLIDATED STATEMENTS OF EQUITY - USD ($) $ in Thousands	Total	Common Stock	Treasury	Additional Paid-In Capital	Accumulated Other Comprehensive Loss	Accumulated Deficit
Beginning balance, shares (in shares) at Dec. 31, 2017		560,023,745	549,907
Beginning balance at Dec. 31, 2017	$ 1,843,623	$ 5,600	$ (1,791)	$ 2,889,256	$ (528)	$ (1,048,914)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity-based compensation expense	11,514			11,514
Exercise of Common Stock options and warrants, shares (in shares)		145,677
Exercise of Common Stock options and warrants	318	$ 2		316
Net loss	(49,315)					(49,315)
Other comprehensive loss	(7,600)				(7,600)
Ending balance, shares (in shares) at Jun. 30, 2018		560,169,422	549,907
Ending balance at Jun. 30, 2018	1,798,540	$ 5,602	$ (1,791)	2,901,086	(13,004)	(1,093,353)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Adoption of ASU 2018-07	0
Beginning balance, shares (in shares) at Mar. 31, 2018		560,023,745	549,907
Beginning balance at Mar. 31, 2018	1,811,310	$ 5,600	$ (1,791)	2,895,192	(539)	(1,087,152)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity-based compensation expense	5,578			5,578
Exercise of Common Stock options and warrants, shares (in shares)		145,677
Exercise of Common Stock options and warrants	318	$ 2		316
Net loss	(6,201)					(6,201)
Other comprehensive loss	(12,465)				(12,465)
Ending balance, shares (in shares) at Jun. 30, 2018		560,169,422	549,907
Ending balance at Jun. 30, 2018	1,798,540	$ 5,602	$ (1,791)	2,901,086	(13,004)	(1,093,353)
Beginning balance, shares (in shares) at Dec. 31, 2018		586,881,720	549,907
Beginning balance at Dec. 31, 2018	1,791,291	$ 5,869	$ (1,791)	3,004,422	(20,131)	(1,197,078)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity-based compensation expense	7,579			7,579
Exercise of Common Stock options and warrants, shares (in shares)		19,232
Exercise of Common Stock options and warrants	(3)			(3)
2025 convertible notes including share lending arrangement (in shares)		29,250,000
2025 convertible notes including share lending arrangement	50,852	$ 293		50,559
Net loss	(140,568)					(140,568)
Other comprehensive loss	(220)				(220)
Ending balance, shares (in shares) at Jun. 30, 2019		616,150,952	549,907
Ending balance at Jun. 30, 2019	1,708,931	$ 6,162	$ (1,791)	3,061,631	(20,351)	(1,336,720)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Adoption of ASU 2018-07	0
Beginning balance, shares (in shares) at Mar. 31, 2019		616,150,952	549,907
Beginning balance at Mar. 31, 2019	1,762,737	$ 6,162	$ (1,791)	3,058,509	(23,229)	(1,276,914)
Increase (Decrease) in Stockholders' Equity [Roll Forward]
Equity-based compensation expense	3,122			3,122
Net loss	(59,806)					(59,806)
Other comprehensive loss	2,878				2,878
Ending balance, shares (in shares) at Jun. 30, 2019		616,150,952	549,907
Ending balance at Jun. 30, 2019	$ 1,708,931	$ 6,162	$ (1,791)	$ 3,061,631	$ (20,351)	$ (1,336,720)

CONDENSED CONSOLIDATED STATEM_3

CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018
Cash flows from operating activities:
Net loss	$ (140,568)	$ (49,315)
Adjustments to reconcile net loss to net cash provided by (used in) operating activities:
Depreciation and amortization	47,477	49,518
Non-cash interest	2,868	2,198
Amortization of deferred financing costs	308	99
Losses from investments in investees	2,125	9,669
Equity-based compensation – employees and non-employees	7,579	11,514
Loss (gain) on disposal of fixed assets	220	(495)
Change in fair value of equity securities and derivative instruments	5,431	(14,819)
Change in fair value of contingent consideration	1,031	(13,599)
Impairment of assets	655	0
Deferred income tax (benefit) provision	168	(2,026)
Changes in assets and liabilities, net of the effects of acquisitions:
Accounts receivable, net	(4,398)	12,440
Inventory, net	(6,225)	894
Other current assets and prepaid expenses	2,476	(3,730)
Other assets	136	(146)
Accounts payable	12,887	(8,092)
Foreign currency measurement	131	(77)
Contract liabilities	(37,015)	(30,812)
Accrued expenses and other liabilities	2,095	(15,820)
Net cash used in operating activities	(102,619)	(52,599)
Cash flows from investing activities:
Investments in investees	(1,200)	(1,000)
Proceeds from sale of equity securities	0	1,286
Proceeds from the sale of property, plant and equipment	309	840
Capital expenditures	(6,432)	(12,792)
Net cash used in investing activities	(7,323)	(11,666)
Cash flows from financing activities:
Issuance of convertible notes, including to related parties	200,293	55,000
Debt issuance costs	(7,762)	0
Proceeds from the exercise of Common Stock options and warrants	(3)	318
Borrowings on lines of credit	39,695	18,817
Repayments of lines of credit	(78,824)	(20,924)
Redemption of 2033 Senior Notes	(28,800)	0
Net cash provided by financing activities	124,599	53,211
Effect of exchange rate changes on cash and cash equivalents	(15)	(64)
Net increase (decrease) in cash and cash equivalents	14,642	(11,118)
Cash and cash equivalents at beginning of period	96,473	91,499
Cash and cash equivalents at end of period	111,115	80,381
SUPPLEMENTAL INFORMATION:
Interest paid	5,411	785
Income taxes paid, net of refunds	2,132	5,251
Operating lease right-of-use assets due to adoption of ASU No. 2016-02	29,640
Operating lease liabilities due to adoption of ASU No. 2016-02	30,049
Shares issued upon the conversion of:
Common Stock options and warrants, surrendered in net exercise	$ 20	$ 806

Business and Organization

Business and Organization	6 Months Ended
	Jun. 30, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
BUSINESS AND ORGANIZATION	BUSINESS AND ORGANIZATION We are a diversified healthcare company that seeks to establish industry-leading positions in large and rapidly growing medical markets. Our diagnostics business includes BioReference Laboratories, Inc. (“BioReference”), the nation’s third-largest clinical laboratory with a core genetic testing business and an almost 300 -person sales and marketing team focused on driving growth and leveraging new products, including the 4Kscore prostate cancer test. Our pharmaceutical business features Rayaldee , an FDA-approved treatment for secondary hyperparathyroidism (“SHPT”) in adults with stage 3 or 4 chronic kidney disease (“CKD”) and vitamin D insufficiency (launched in November 2016); OPK88004, a selective androgen receptor modulator which we are exploring for various potential indications; and OPK88003, a once or twice weekly oxyntomodulin for type 2 diabetes and obesity which is a clinically advanced drug candidate among the new class of GLP-1 glucagon receptor dual agonists (phase 2b). Our pharmaceutical business also features hGH-CTP, a once-weekly human growth hormone injection (in phase 3 and partnered with Pfizer). We are incorporated in Delaware and our principal executive offices are located in leased offices in Miami, Florida. Through BioReference, we provide laboratory testing services, primarily to customers in the larger metropolitan areas across New York, New Jersey, Maryland, Pennsylvania, Delaware, Washington, DC, Florida, California, Texas, Illinois and Massachusetts as well as to customers in a number of other states. We offer a comprehensive test menu of clinical diagnostics for blood, urine, and tissue analysis. This includes hematology, clinical chemistry, immunoassay, infectious diseases, serology, hormones, and toxicology assays, as well as Pap smear, anatomic pathology (biopsies) and other types of tissue analysis. We market our laboratory testing services directly to physicians, geneticists, hospitals, clinics, correctional and other health facilities. We operate established pharmaceutical platforms in Ireland, Chile, Spain, and Mexico, which are generating revenue and which we expect to facilitate future market entry for our products currently in development. In addition, we have a development and commercial supply pharmaceutical company and a global supply chain operation and holding company in Ireland. We own a specialty active pharmaceutical ingredients (“APIs”) manufacturer in Israel, which we expect will facilitate the development of our pipeline of molecules and compounds for our molecular diagnostic and therapeutic products. Our research and development activities are primarily performed at facilities in Miramar, FL, Woburn, MA, Waterford, Ireland, Kiryat Gat, Israel, and Barcelona, Spain.

Summary of Significant Accounti

Summary of Significant Accounting Policies	6 Months Ended
	Jun. 30, 2019
Accounting Policies [Abstract]
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES	SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES Basis of presentation . The accompanying unaudited Condensed Consolidated Financial Statements have been prepared in accordance with accounting principles generally accepted in the U.S. (“GAAP”) and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all information and notes required by GAAP for complete financial statements. In the opinion of management, all adjustments (consisting of only normal recurring adjustments or otherwise disclosed herein) considered necessary to present fairly the Company’s results of operations, financial position and cash flows have been made. The results of operations and cash flows for the three and six months ended June 30, 2019 are not necessarily indicative of the results of operations and cash flows that may be reported for the remainder of 2019 or any other future periods. The unaudited Condensed Consolidated Financial Statements should be read in conjunction with the audited Consolidated Financial Statements and the Notes to Consolidated Financial Statements included in our Annual Report on Form 10-K for the year ended December 31, 2018 . Principles of consolidation . The accompanying unaudited Condensed Consolidated Financial Statements include the accounts of OPKO Health, Inc. and of our wholly-owned subsidiaries. All intercompany accounts and transactions are eliminated in consolidation. Use of estimates . The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ significantly from these estimates. Cash and cash equivalents . Cash and cash equivalents include short-term, interest-bearing instruments with original maturities of 90 days or less at the date of purchase. We also consider all highly liquid investments with original maturities at the date of purchase of 90 days or less as cash equivalents. These investments include money markets, bank deposits, certificates of deposit and U.S. treasury securities. Inventories . Inventories are valued at the lower of cost and net realizable value. Cost is determined by the first-in, first-out method. We consider such factors as the amount of inventory on hand, estimated time required to sell such inventories, remaining shelf-life, and current market conditions to determine whether inventories are stated at the lower of cost and net realizable value. Inventories at our diagnostics segment consist primarily of purchased laboratory supplies, which is used in our testing laboratories. Inventory obsolescence expense for the six months ended June 30, 2019 and 2018 was $1.3 million and $1.2 million , respectively. Pre-launch inventories . We may accumulate commercial quantities of certain product candidates prior to the date we anticipate that such products will receive final U.S. FDA approval. The accumulation of such pre-launch inventories involves the risk that such products may not be approved for marketing by the FDA on a timely basis, or ever. This risk notwithstanding, we may accumulate pre-launch inventories of certain products when such action is appropriate in relation to the commercial value of the product launch opportunity. In accordance with our policy, this pre-launch inventory is expensed. Goodwill and intangible assets . Goodwill represents the difference between the purchase price and the estimated fair value of the net assets acquired accounted for by the acquisition method of accounting. Refer to Note 4. Goodwill, in-process research and development (“IPR&D”) and other intangible assets acquired in business combinations, licensing and other transactions at June 30, 2019 and December 31, 2018 was $1.9 billion and $2.0 billion , respectively. 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. We determined the fair value of intangible assets, including IPR&D, using the “income method.” Goodwill is tested at least annually for impairment, or when events or changes in circumstances indicate that the carrying amount of such assets may not be recoverable, by assessing qualitative factors or performing a quantitative analysis in determining whether it is more likely than not that its fair value exceeds the carrying value. Estimating the fair value of a reporting unit for goodwill impairment is highly sensitive to changes in projections and assumptions; therefore, in some instances, changes in these 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, future potential changes in these assumptions may impact the estimated fair value of a reporting unit and cause the fair value of the reporting unit to be below its carrying value. We believe that our estimates are consistent with assumptions that marketplace participants would use in their estimates of fair value. However, if actual results are not consistent with our estimates and assumptions, we may be exposed to an impairment charge that could be material. For the three and six months periods ending June 30, 2019, the results of operations of our BioReference reporting unit were below management’s forecast of expected cash flows due to a change in reimbursement coverage for our 4Kscore test and other market factors. If we are unable to obtain appropriate reimbursement for our 4Kscore test and experience sustained declines in operating results versus forecast, our estimates of the fair value of the BioReference reporting unit may change. If the fair value of the reporting unit falls below carrying value, we would record impairment of goodwill at BioReference and such impairment could be significant. Intangible assets are tested for impairment whenever events or changes in circumstances indicate that the carrying amount of such assets may not be recoverable, although IPR&D is required to be tested at least annually until the project is completed or abandoned. Upon obtaining regulatory approval, the IPR&D asset is then accounted for as a finite-lived intangible asset and amortized on a straight-line basis over its estimated useful life. If the project is abandoned, the IPR&D asset is charged to expense. The cost and duration of the development project for hGH-CTP have exceeded our original estimates and will result in additional expenses beyond our estimates and the agreed development cap. If we are unable to reach an agreement with Pfizer regarding cost sharing for overruns, as well as other obligations, including development obligations, it could have a material adverse impact on the expected benefits of the Pfizer transaction. If we are unable to successfully develop hGH-CTP, or if changes in projections and assumptions negatively impact our forecast of net cash flows, then we may be exposed to a material impairment charge related to the IPR&D for hGH-CTP. 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 reliably determinable pattern in which the economic benefits of our intangible assets are consumed or otherwise used up. Amortization expense was $33.0 million and $34.5 million for the six months ended June 30, 2019 and 2018 , respectively. Fair value measurements . The carrying amounts of our cash and cash equivalents, accounts receivable, accounts payable and short-term debt approximate their fair value due to the short-term maturities of these instruments. Investments that are considered equity securities as of June 30, 2019 and December 31, 2018 are predominately carried at fair value. Our debt under our credit agreement with JPMorgan Chase Bank, N.A. approximates fair value due to the variable rate of interest. 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 have a material effect on the estimated fair value amounts. Accordingly, the estimates of fair value presented herein may not be indicative of the amounts that could be realized in a current market exchange. Refer to Note 8. Contingent consideration . Each period we revalue the contingent consideration obligations associated with certain prior acquisitions to their fair value and record increases in the fair value as contingent consideration expense and decreases in the fair value as a reduction in contingent consideration expense. Changes in contingent consideration result from changes in the assumptions regarding probabilities of successful achievement of related milestones, the estimated timing in which the milestones are achieved and the discount rate used to estimate the fair value of the liability. Contingent consideration may change significantly as our development programs progress, revenue estimates evolve and additional data is obtained, impacting our assumptions. The assumptions used in estimating fair value require significant judgment. The use of different assumptions and judgments could result in a materially different estimate of fair value which may have a material impact on our results from operations and financial position. Derivative financial instruments . We record derivative financial instruments on our Condensed Consolidated Balance Sheet at their fair value and recognize the changes in the fair value in our Condensed Consolidated Statement of Operations when they occur, the only exception being derivatives that qualify as hedges. For the derivative instrument to qualify 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 June 30, 2019 and December 31, 2018 , our foreign currency forward contracts held to economically hedge inventory purchases did not meet the documentation requirements to be designated as hedges. Accordingly, we recognize all changes in the fair values of our derivatives instruments, net, in our Condensed Consolidated Statement of Operations. Refer to Note 9. Property, plant and equipment . Property, plant and equipment are recorded at cost. Depreciation is provided using the straight-line method over the estimated useful lives of the assets and includes amortization expense for assets capitalized under finance leases. The estimated useful lives by asset class are as follows: software - 3 years, machinery, medical and other equipment - 5 - 8 years, furniture and fixtures - 5 - 12 years, leasehold improvements - the lesser of their useful life or the lease term, buildings and improvements - 10 - 40 years, and automobiles - 3 - 5 years. Expenditures for repairs and maintenance are charged to expense as incurred. Depreciation expense was $14.5 million and $15.0 million for the six months ended June 30, 2019 and 2018, respectively. Assets held under finance leases are included within Property, plant and equipment, net in our Condensed Consolidated Balance Sheet and are amortized over the shorter of their useful lives or the expected term of their related leases. Impairment of long-lived assets. Long-lived assets, such as property and equipment, are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset to estimated undiscounted future cash flows expected to be generated by the asset. If the carrying amount of an asset exceeds its estimated future cash flows, then an impairment charge is recognized for the amount by which the carrying amount of the asset exceeds the fair value of the asset. Income taxes. Income taxes are accounted for under the asset-and-liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and the respective tax bases and for operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in operations in the period that includes the enactment date. We periodically evaluate the realizability of our net deferred tax assets. Our tax accruals are analyzed periodically and adjustments are made as events occur to warrant such adjustment. Valuation allowances on certain U.S. deferred tax assets and non-U.S. deferred tax assets are established, because realization of these tax benefits through future taxable income does not meet the more-likely-than-not threshold. 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 three and six months ended June 30, 2019 , the tax rate differed from the U.S. federal statutory rate of 21% primarily due to the valuation allowance against certain U.S. and non-U.S. deferred tax assets, the relative mix in earnings and losses in the U.S. versus foreign tax jurisdictions, and the impact of certain discrete tax events and operating results in tax jurisdictions which do not result in a tax benefit. Revenue recognition . We recognize revenue when a customer obtains control of promised goods or services in accordance with Accounting Standards Codification Topic 606, Revenue from Contracts with Customers (“Topic 606”). The amount of revenue that is recorded reflects the consideration that we expect to receive in exchange for those goods or services. We apply the following five-step model in order to determine this amount: (i) identify the contract(s) with a customer; (ii) identify the performance obligations in the contract; (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligations in the contract; and (v) recognize revenue when (or as) we satisfy a performance obligation. We apply the five-step model to contracts when it is probable that we will collect the consideration we are entitled to in exchange for the goods or services we transfer to the customer. At contract inception, once the contract is determined to be within the scope of Topic 606, we review the contract to determine which performance obligations we must deliver and which of these performance obligations are distinct. We recognize as revenue the amount of the transaction price that is allocated to the respective performance obligation when the performance obligation is satisfied or as it is satisfied. For a complete discussion of accounting for Revenues from services, Revenues from products and Revenue from transfer of intellectual property and other, refer to Note 12. Concentration of credit risk and allowance for doubtful accounts . Financial instruments that potentially subject us to concentrations of credit risk consist primarily of accounts receivable. Substantially all of our accounts receivable are with either companies in the healthcare industry or patients. However, credit risk is limited due to the number of our clients as well as their dispersion across many different geographic regions. While we have receivables due from federal and state governmental agencies, we do not believe that such receivables represent a credit risk because the related healthcare programs are funded by federal and state governments, and payment is primarily dependent upon submitting appropriate documentation. At June 30, 2019 and December 31, 2018 , receivable balances (net of contractual adjustments) from Medicare and Medicaid were 9.6% and 7.4% , respectively, of our consolidated Accounts receivable, net. The portion of our accounts receivable due from individual patients comprises the largest portion of credit risk. At June 30, 2019 and December 31, 2018 , receivables due from patients represented approximately 2.0% and 2.9% , respectively, of our consolidated Accounts receivable, net. 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 affect a customer’s ability to pay. Actual results could differ from those estimates. Our reported net loss is directly affected by our estimate of the collectability of accounts receivable. The allowance for doubtful accounts was $2.1 million and $1.8 million at June 30, 2019 and December 31, 2018 , respectively. The provision for bad debts for the six months ended June 30, 2019 and 2018 was $0.2 million and $0.2 million , respectively. Equity-based compensation . We measure the cost of services received in exchange for an award of equity instruments based on the grant-date fair value of the award. That cost is recognized in the Condensed Consolidated Statement of Operations over the period during which an employee is required to provide service in exchange for the award. We record excess tax benefits realized from the exercise of stock options as cash flows from operations. During the six months ended June 30, 2019 and 2018 , we recorded $7.6 million and $11.5 million , respectively, of equity-based compensation expense. Research and development expenses. Research and development expenses include external and internal expenses. External expenses include clinical and non-clinical activities performed by contract research organizations, lab services, purchases of drug and diagnostic product materials and manufacturing development costs. Research and development employee-related expenses include salaries, benefits and equity-based compensation expense. Other internal research and development expenses are incurred to support overall research and development activities and include expenses related to general overhead and facilities. We expense these costs in the period in which they are incurred. We estimate our liabilities for research and development expenses in order to match the recognition of expenses to the period in which the actual services are received. As such, accrued liabilities related to third party research and development activities are recognized based upon our estimate of services received and degree of completion of the services in accordance with the specific third party contract. Research and development expense includes costs for in-process research and development projects acquired in asset acquisitions which have not reached technological feasibility and which have no alternative future use. For in-process research and development projects acquired in business combinations, the in-process research and development project is capitalized and evaluated for impairment until the development process has been completed. Once the development process has been completed the asset will be amortized over its remaining useful life. Segment reporting . Our chief operating decision-maker (“CODM”) is Phillip Frost, M.D., our Chairman and Chief Executive Officer. Our CODM reviews our operating results and operating plans and makes resource allocation decisions on a Company-wide or aggregate basis. We manage our operations in two reportable segments, pharmaceutical and diagnostics. The pharmaceutical segment consists of our pharmaceutical operations in Chile, Mexico, Ireland, Israel and Spain, Rayaldee product sales and our pharmaceutical research and development. The diagnostics segment primarily consists of clinical laboratory operations through BioReference and point-of-care operations. There are no significant inter-segment sales. We evaluate the performance of each segment based on operating profit or loss. There is no inter-segment allocation of interest expense and income taxes. Refer to Note 14. Shipping and handling costs. We do not charge customers for shipping and handling costs. Shipping and handling costs are classified as Cost of revenues in the Condensed Consolidated Statement of Operations. Foreign currency translation . The financial statements of certain of our foreign operations are measured using the local currency as the functional currency. The local currency assets and liabilities are generally translated at the rate of exchange to the U.S. dollar on the balance sheet date and the local currency revenues and expenses are translated at average rates of exchange to the U.S. dollar during the reporting periods. Foreign currency transaction gains (losses) have been reflected as a component of Other income (expense), net within the Condensed Consolidated Statement of Operations and foreign currency translation gains (losses) have been included as a component of the Condensed Consolidated Statement of Comprehensive Loss. Variable interest entities . The consolidation of a variable interest entity (“VIE”) is required when an enterprise has a controlling financial interest. A controlling financial interest in a VIE will have both of the following characteristics: (a) the power to direct the activities of a VIE that most significantly impact the VIE’s economic performance and (b) the obligation to absorb losses of the VIE that could potentially be significant to the VIE. Refer to Note 5. Investments . We have made strategic investments in development stage and emerging companies. We record these investments as equity method investments or as equity securities based on our percentage of ownership and whether we have significant influence over the operations of the investees. For investments classified under the equity method of accounting, we record our proportionate share of their losses in Losses from investments in investees in our Condensed Consolidated Statement of Operations. Refer to Note 5. For investments classified as equity securities, we record changes in their fair value as Other income (expense) in our Condensed Consolidated Statement of Operations based on their closing price per share at the end of each reporting period, unless the equity security does not have a readily determinable fair value. Refer to Note 5. Recently adopted accounting pronouncements . In February 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") No. 2016-02, “Leases (Topic 842),” which requires organizations that lease assets with lease terms of more than 12 months to recognize assets and liabilities for the rights and obligations created by those leases on their balance sheets. ASU 2016-02, as amended and codified under Topic 842, requires new qualitative and quantitative disclosures to help investors and other financial statement users better understand the amount, timing, and uncertainty of cash flows arising from leases. As required, we adopted Topic 842 on January 1, 2019 using the modified retrospective approach for all lease arrangements at the beginning or the period of adoption. Results for reporting periods beginning January 1, 2019 are presented under Topic 842, while prior period amounts were not adjusted and continue to be reported in accordance our historic accounting under ASC 840. For leases that commenced before the effective date of Topic 842, we elected the permitted practical expedients to not reassess the following: (i) whether any expired or existing contracts contain leases (ii) the lease classification for any expired or existing leases and (iii) initial direct costs for any existing leases. We also elected the policy of not recording leases on our Condensed Consolidated Balance Sheet when the leases have a term of 12 months or less and we elected not to separate nonlease components from lease components and instead account for each separate lease component and the nonlease components associated with that lease component as a single lease component. The adoption of Topic 842 resulted in the recognition of operating lease liabilities of approximately $33.7 million and operating lease right-to-use assets of approximately $33.3 million as of March 31, 2019, primarily related to operating leases for our diagnostic facilities, based on the present value of lease payments over the lease term. There was no cumulative-effect adjustment to beginning Accumulated deficit on the Condensed Consolidated Balance Sheet. The accounting for our finance leases remains substantially unchanged, as finance lease liabilities and their corresponding right-to-use assets were already recorded on the Condensed Consolidated Balance Sheet under the previous guidance. The adoption of Topic 842 did not have a significant effect on our results of operations or cash flows. Refer to Note 15 for additional disclosures required by Topic 842. In February 2018, the FASB issued ASU No. 2018-02, "Income Statement-Reporting Comprehensive Income (Topic 220)." This standard provides an option to reclassify stranded tax effects within accumulated other comprehensive loss to retained earnings due to the U.S. federal corporate income tax rate change in the Tax Cuts and Jobs Act of 2017. This standard is effective for interim and annual reporting periods beginning after December 15, 2018. We adopted this standard effective January 1, 2019 with the election not to reclassify immaterial amounts of stranded tax effects from accumulated other comprehensive loss to retained earnings. In June 2018, the FASB issued ASU No. 2018-07, “Compensation - Stock Compensation (Topic 718),” which expands the scope of Topic 718 to include share-based payment transactions for acquiring goods and services from non-employees. The adoption of ASU 2018-07 on January 1, 2019, did not have a significant impact on our Condensed Consolidated Financial Statements. Pending accounting pronouncements . In June 2016, the FASB issued ASU No. 2016-13, “Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments,” which amends the impairment model by requiring entities to use a forward-looking approach based on expected losses rather than incurred losses to estimate credit losses on certain types of financial instruments, including trade receivables. This may result in the earlier recognition of allowances for losses. The The ASU is effective for public entities for fiscal years beginning after December 15, 2019, with early adoption permitted. We are currently evaluating the impact of this new guidance on our Condensed Consolidated Financial Statements.

Earnings (Loss) Per Share

Earnings (Loss) Per Share	6 Months Ended
	Jun. 30, 2019
Earnings Per Share [Abstract]
EARNINGS (LOSS) PER SHARE	EARNINGS (LOSS) PER SHARE Basic loss per share is computed by dividing our net loss by the weighted average number of shares of our common stock par value $0.01 per share (“Common Stock”) outstanding during the period. Shares of Common Stock outstanding under the share lending arrangement entered into in conjunction with the 2025 Notes (as defined in Note 6) are excluded from the calculation of basic and diluted earnings per share because the share lending arrangement and the borrower of the shares is required to refund any dividends paid on the shares lent. Refer to Note 6. For diluted earnings per share, the dilutive impact of stock options and warrants is determined by applying the “treasury stock” method. The dilutive impact of the 2033 Senior Notes, the 2023 Convertible Notes and the 2025 Notes (each, as defined herein and as discussed in Note 6) has been considered using the “if converted” method. In the periods in which their effect would be antidilutive, no effect is given to outstanding options, warrants or the potentially dilutive shares issuable pursuant to the 2033 Senior Notes, the 2023 Convertible Notes and the 2025 Notes in the dilutive computation. A total of 68,933,402 and 61,760,134 potential shares of Common Stock have been excluded from the calculation of diluted net loss per share for the three and six months ended June 30, 2019 , respectively, because their inclusion would be antidilutive. A full presentation of diluted earnings per share has not been provided because the required adjustments to the numerator and denominator resulted in diluted earnings per share equivalent to basic earnings per share. During the three months ended June 30, 2019 , no Common Stock options and Common Stock warrants to purchase shares of our Common Stock were exercised, resulting in the issuance of no shares of Common Stock. During the six months ended June 30, 2019 , 24,877 Common Stock options and Common Stock warrants to purchase shares of our Common Stock were exercised, resulting in the issuance of 19,232 shares of Common Stock. Of the 24,877 Common Stock options and Common Stock warrants exercised, 5,645 shares of Common Stock were surrendered in lieu of a cash payment via the net exercise feature of the agreements. During the three months ended June 30, 2018, 332,000 Common Stock options and Common Stock warrants to purchase shares of our Common Stock were exercised, resulting in the issuance of 145,677 shares of Common Stock. Of the 332,000 Common Stock options and Common Stock warrants exercised, 186,323 shares of Common Stock were surrendered in lieu of a cash payment via the net exercise feature of the agreements. During the six months ended June 30, 2018, 332,000 Common Stock options and Common Stock warrants to purchase shares of our Common Stock were exercised, resulting in the issuance of 145,677 shares of Common Stock. Of the 332,000 Common Stock options and Common Stock warrants exercised, 186,323 shares of Common Stock were surrendered in lieu of a cash payment via the net exercise feature of the agreements.

Composition of Certain Financia

Composition of Certain Financial Statement Captions	6 Months Ended
	Jun. 30, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
COMPOSITION OF CERTAIN FINANCIAL STATEMENT CAPTIONS	COMPOSITION OF CERTAIN FINANCIAL STATEMENT CAPTIONS (In thousands) June 30, December 31, Accounts receivable, net: Accounts receivable $ 150,414 $ 145,665 Less: allowance for doubtful accounts (2,127 ) (1,758 ) $ 148,287 $ 143,907 Inventories, net: Consumable supplies $ 22,008 $ 23,264 Finished products 21,481 15,259 Work in-process 3,096 2,473 Raw materials 4,741 4,259 Less: inventory reserve (3,033 ) (2,956 ) $ 48,293 $ 42,299 Other current assets and prepaid expenses: Taxes recoverable 18,176 15,708 Other receivables 661 2,368 Prepaid supplies 10,584 9,693 Prepaid insurance 3,878 3,436 Other 3,234 3,847 $ 36,533 $ 35,052 Intangible assets, net: Customer relationships $ 446,144 $ 446,296 Technologies 340,702 340,729 Trade names 50,420 50,404 Licenses 5,766 5,766 Covenants not to compete 16,321 16,322 Product registrations 8,016 7,861 Other 5,586 5,613 Less: accumulated amortization (291,649 ) (258,539 ) $ 581,306 $ 614,452 Accrued expenses: Contract liabilities $ 50,388 $ 63,503 Employee benefits 39,453 45,621 Clinical trials 9,936 10,401 Contingent consideration 5,387 2,375 Finance leases short-term 3,031 3,280 Milestone payment 4,968 4,871 Professional fees 3,317 7,935 Other 81,902 65,527 $ 198,382 $ 203,513 (In thousands) June 30, December 31, Other long-term liabilities: Contract liabilities $ 3,665 $ 27,566 Line of credit 65,112 105,198 Contingent consideration 20,181 22,162 Mortgages and other debts payable 4,500 4,654 Finance leases long-term 4,650 5,620 Other 29,643 33,768 $ 127,751 $ 198,968 Our intangible assets and goodwill relate principally to our prior acquisitions of OPKO Renal, OPKO Biologics, EirGen Pharma Limited (“EirGen”) and BioReference. 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 - 5 - 17 years , customer relationships - 7 - 20 years , product registrations - 7 - 10 years , covenants not to compete - 5 years , trade names - 5 - 10 years , other 9 - 10 years . We do not anticipate capitalizing the cost of product registration renewals, rather we expect to expense these costs, as incurred. Our goodwill is not tax deductible for income tax purposes in any jurisdiction in which we operate. The changes in value of the intangible assets and goodwill during the six months ended June 30, 2019 were primarily due to foreign currency fluctuations between the Chilean Peso, the Euro and the Shekel against the U.S. dollar. The following table summarizes the changes in Goodwill during the six months ended June 30, 2019 . 2019 (In thousands) Balance at January 1 Foreign exchange and other Balance at June 30th Pharmaceuticals CURNA $ 4,827 $ — $ 4,827 EirGen 85,245 (551 ) 84,694 FineTech — — — OPKO Chile 4,614 112 4,726 OPKO Biologics 139,784 — 139,784 OPKO Health Europe 7,545 (49 ) 7,496 OPKO Renal 2,069 — 2,069 Transition Therapeutics 3,323 137 3,460 Diagnostics BioReference 401,821 — 401,821 OPKO Diagnostics 17,977 — 17,977 OPKO Lab 32,988 — 32,988 $ 700,193 $ (351 ) $ 699,842

Investments

Investments	6 Months Ended
	Jun. 30, 2019
Business Combinations [Abstract]
INVESTMENTS	INVESTMENTS Investments The following table reflects the accounting method, carrying value and underlying equity in net assets of our unconsolidated investments as of June 30, 2019 : (in thousands) Investment type Investment Carrying Value Underlying Equity in Net Assets Equity method investments $ 1,975 $ 10,616 Variable interest entity, equity method 1,010 — Equity securities 20,856 Equity securities with no readily determinable fair value 438 Warrants and options 488 Total carrying value of investments $ 24,767 Equity method investments Our equity method investments consist of investments in Pharmsynthez (ownership 9% ), Cocrystal Pharma, Inc. (“COCP”) ( 8% ), Non-Invasive Monitoring Systems, Inc. (“NIMS”) ( 1% ), Neovasc, Inc. (“Neovasc”) ( 5% ), InCellDx, Inc. (“InCellDx”) ( 29% ), BioCardia, Inc. (“BioCardia”) ( 5% ), and Xenetic Biosciences, Inc. (“Xenetic”) ( 4% ). The total assets, liabilities, and net losses of our equity method investees as of and for the six months ended June 30, 2019 were $183.7 million , $51.9 million , and $23.3 million , respectively. We have determined that we and/or our related parties can significantly influence the success of our equity method investments through our board representation and/or voting power. Accordingly, we account for our investment in these entities under the equity method and record our proportionate share of their losses in Loss from investments in investees in our Condensed Consolidated Statement of Operations. The aggregate value of our equity method investments based on the quoted market price of their respective shares of common stock and the number of shares held by us as of June 30, 2019 , was $12.5 million . Equity Securities Our equity securities consist of investments in Phio Pharmaceuticals (“Phio”) (ownership 0.2% ), VBI Vaccines Inc. (“VBI”) ( 7% ), ChromaDex Corporation (“ChromaDex”) ( 0.1% ), MabVax Therapeutics Holdings, Inc. (“MabVax”) ( 1% ), and Eloxx Pharmaceuticals, Inc. (“Eloxx”) ( 4% ). We have determined that our ownership, along with that of our related parties, does not provide us with significant influence over the operations of these investments. Accordingly, we account for our investment in these entities as equity securities, and we record changes in the fair value of these investments in Other income (expense) each reporting period when they have readily determinable fair value. Equity securities without a readily determinable fair value are adjusted to fair value when an observable price change can be identified. Net gains and losses on our equity securities for the six months ended June 30, 2019 are as follows: (in thousands) Equity Securities For the six months ended June 30, 2019 Net gains and losses recognized during the period on equity securities $ (5,458 ) Less: Net gains and losses realized during the period on equity securities — Unrealized net gains recognized during the period on equity securities still held at the reporting date $ (5,458 ) 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. We did not have significant sales activity during the six months ended June 30, 2019 and 2018. 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, 23 thousand of which were vested as of June 30, 2019 , and 33 thousand , 0.7 million , 40 thousand and 22 thousand of warrants to purchase additional shares of COCP, InCellDx, Inc., Xenetic, and Phio, respectively. We recorded the changes in the fair value of the options and warrants in Fair value changes of derivative instruments, net in our Condensed Consolidated Statement of Operations. We also recorded the fair value of the options and warrants in Investments, net in our Condensed Consolidated Balance Sheet. See further discussion of the Company’s options and warrants in Note 8 and Note 9. Investments in variable interest entities We have determined that we hold variable interests in Zebra Biologics, Inc. (“Zebra”). We made this determination as a result of our assessment that Zebra does not have sufficient resources to carry out its principal activities without additional financial support. We own 1,260,000 shares of Zebra Series A-2 Preferred Stock and 900,000 shares of Zebra restricted common stock (ownership 29% at June 30, 2019 ). Zebra is a privately held biotechnology company focused on the discovery and development of biosuperior antibody therapeutics and complex drugs. Dr. Richard Lerner, M.D., a member of our Board of Directors, is a founder of Zebra and, along with Dr. Frost, serves as a member of Zebra’s Board of Directors. 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 party group’s 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 have the power to direct the activities that most significantly impact Zebra’s economic performance and have no obligation to fund expected losses. We did determine, however, that we can significantly influence the success of Zebra through our board representation and voting power. Therefore, we have the ability to exercise significant influence over Zebra’s operations and account for our investment in Zebra under the equity method.

Debt

Debt	6 Months Ended
	Jun. 30, 2019
Debt Disclosure [Abstract]
DEBT	DEBT In February 2019, we issued $200.0 million aggregate principal amount of Convertible Senior Notes due 2025 (the “2025 Notes”) in an underwritten public offering. The 2025 Notes bear interest at a rate of 4.50% per year, payable semiannually in arrears on February 15 and August 15 of each year, beginning on August 15, 2019. The notes mature on February 15, 2025, unless earlier repurchased, redeemed or converted. Holders may convert their 2025 Notes into shares of Common Stock at their option at any time prior to the close of business on the business day immediately preceding November 15, 2024 only under the following circumstances: (1) during any calendar quarter commencing after the calendar quarter ended on March 31, 2019 (and only during such calendar quarter), if the last reported sale price of our Common Stock for at least 20 trading days (whether or not consecutive) during a period of 30 consecutive trading days ending on the last trading day of the immediately preceding calendar quarter is greater than or equal to 130% of the conversion price on each applicable trading day; (2) during the five business day period after any five consecutive trading day period (the “measurement period”) in which the trading price per $1,000 principal amount of 2025 Notes for each trading day of the measurement period was less than 98% of the product of the last reported sale price of our Common Stock and the conversion rate on each such trading day; (3) if we call any or all of the 2025 Notes for redemption, at any time prior to the close of business on the scheduled trading day immediately preceding the redemption date; or (4) upon the occurrence of specified corporate events set forth in the indenture governing the 2025 Notes. On or after November 15, 2024, until the close of business on the business day immediately preceding the maturity date, holders of the 2025 Notes may convert their notes at any time, regardless of the foregoing circumstances. Upon conversion, we will pay or deliver, as the case may be, cash, shares of our Common Stock, or a combination of cash and shares of our Common Stock, at our election. The initial and current conversion rate for the 2025 Notes is 236.7424 shares of Common Stock per $1,000 principal amount of 2025 Notes (equivalent to an initial conversion price of approximately $4.22 per share of Common Stock). The conversion rate for the 2025 Notes will be subject to adjustment in some events, but will not be adjusted for any accrued and unpaid interest. In addition, following certain corporate events that occur prior to the maturity date of the notes or if we deliver a notice of redemption, in certain circumstances we will increase the conversion rate of the 2025 Notes for a holder who elects to convert its notes in connection with such a corporate event or notice of redemption, as the case may be. We may not redeem the 2025 Notes prior to February 15, 2022. We may redeem for cash any or all of the notes, at our option, on or after February 15, 2022, if the last reported sale price of our Common Stock has been at least 130% of the conversion price for the notes then in effect for at least 20 trading days (whether or not consecutive) during any 30 consecutive trading day period (including the last trading day of such period) ending on, and including, the trading day immediately preceding the date on which we provide notice of redemption at a redemption price equal to 100% of the principal amount of the notes to be redeemed, plus accrued and unpaid interest to, but excluding, the redemption date. No sinking fund is provided for the 2025 Notes. If we undergo a fundamental change, as defined in the indenture governing the 2025 Notes, prior to the maturity date of the 2025 Notes, holders may require us to repurchase for cash all or any portion of their notes at a repurchase price equal to 100% of the principal amount of the notes to be repurchased, plus accrued and unpaid interest to, but excluding, the fundamental change repurchase date. The 2025 Notes are our senior unsecured obligations and rank senior in right of payment to any of our indebtedness that is expressly subordinated in right of payment to the 2025 Notes; equal in right of payment to any of our existing and future liabilities that are not so subordinated; effectively junior in right of payment to any of our secured indebtedness to the extent of the value of the assets securing such indebtedness; and structurally junior to all indebtedness and other liabilities (including trade payables) of our current or future subsidiaries. In conjunction with the issuance of the 2025 Notes, we agreed to loan up to 30,000,000 shares of our Common Stock to affiliates of the underwriter in order to assist investors in the 2025 Notes to hedge their position. As at June 30, 2019 , a total of 29,250,000 shares were issued under the share lending arrangement. We will not receive any of the proceeds from the sale of the borrowed shares, but we received a one-time nominal fee of $0.3 million for the newly issued shares. Shares of our Common Stock outstanding under the share lending arrangement are excluded from the calculation of basic and diluted earnings per share. See Note 3. As required by ASC 470-20, “Debt with Conversion and Other Options,” we calculated the equity component of the 2025 Notes, taking into account both the fair value of the conversion option and the fair value of the share lending arrangement. The equity component was valued at $52.6 million at issue date and this amount was recorded as Additional paid-in capital, which resulted in a discount on the 2025 Notes. The discount is being amortized to Interest expense over the term of the 2025 Notes, which results in an effective interest rate on the 2025 Notes of 11.2% . The following table sets forth information related to the 2025 Notes which is included in our Condensed Consolidated Balance Sheet as of June 30, 2019 : (In thousands) 2025 Senior Notes Discount Debt Issuance Cost Total Balance at December 31, 2018 $ — $ — $ — $ — Issuance of 4.50% convertible notes 200,000 (52,600 ) (5,720 ) 141,680 Amortization of debt discount and debt issuance costs — 2,483 269 2,752 Balance at June 30, 2019 $ 200,000 $ (50,117 ) $ (5,451 ) $ 144,432 On November 8, 2018, we entered into a credit agreement with an affiliate of Dr. Frost, pursuant to which the lender committed to provide us with an unsecured line of credit in the amount of $60 million . The credit agreement was terminated on or around February 20, 2019 and the $28.8 million outstanding thereunderwas repaid from the proceeds of the 2025 Convertible Notes offering. In February 2018, we issued a series of 5% Convertible Promissory Notes (the “2023 Convertible Notes”) in the aggregate principal amount of $55.0 million . The 2023 Convertible Notes mature 5 years from the date of issuance. Each holder of a 2023 Convertible Note has the option, from time to time, to convert all or any portion of the outstanding principal balance of such 2023 Convertible Note, together with accrued and unpaid interest thereon, into shares of our Common Stock at a conversion price of $5.00 per share of Common Stock (the “Shares”). We may redeem all or any part of the then issued and outstanding 2023 Convertible Notes, together with accrued and unpaid interest thereon, pro rata among the holders, upon no fewer than 30 days, and no more than 60 days, notice to the holders. The 2023 Convertible Notes contain customary events of default and representations and warranties of OPKO. The issuance of the 2023 Convertible Notes and the issuance of the Shares, if any, upon conversion thereof was not, and will not be, respectively, registered under the Securities Act, pursuant to the exemption provided by Section 4(a)(2) thereof, and we have not agreed to register the Shares if or when such Shares are issued. Purchasers of the 2023 Convertible Notes include an affiliate of Dr. Phillip Frost, M.D., our Chairman and Chief Executive Officer, and Dr. Jane H. Hsiao, Ph.D., MBA, our Vice-Chairman and Chief Technical Officer. In January 2013, we entered into note purchase agreements (the “2033 Senior Notes”) with qualified institutional buyers and accredited investors (collectively, the “Purchasers”) in a private placement in reliance on exemptions from registration under the Securities Act. The 2033 Senior Notes were issued on January 30, 2013 . The 2033 Senior Notes, which totaled $175.0 million in original principal amount, bear interest at the rate of 3.00% per year, payable semiannually on February 1 and August 1 of each year. The 2033 Senior Notes will mature on February 1, 2033 , unless earlier repurchased, redeemed or converted. Upon a fundamental change as defined in that certain Indenture, dated as of January 30, 2013, by and between the Company and Wells Fargo Bank N.A., as trustee, governing the 2033 Senior Notes (the “Indenture”), subject to certain exceptions, the holders may require us to repurchase all or any portion of their 2033 Senior Notes for cash at a repurchase price equal to 100% of the principal amount of the 2033 Senior Notes being repurchased, plus any accrued and unpaid interest to but not including the related fundamental change repurchase date. On February 1, 2019, approximately $28.8 million aggregate principal amount of 2033 Senior Notes were tendered by holders pursuant to such holders’ option to require us to repurchase the 2033 Senior Notes as set forth in the Indenture. Holders of the remaining $3.0 million principal amount of the 2033 Senior Notes issued in January 2013 may require us to repurchase the 2033 Senior Notes for 100% of their principal amount, plus accrued and unpaid interest, again on February 1, 2023 and February 1, 2028, or following the occurrence of a fundamental change as defined in the indenture governing the 2033 Senior Notes. The terms of the 2033 Senior Notes, include, among others: (i) rights to convert into shares of our Common Stock, including upon a fundamental change; and (ii) a coupon make-whole payment in the event of a conversion by the holders of the 2033 Senior Notes on or after February 1, 2017 but prior to February 1, 2019. We determined that these specific terms were considered to be embedded derivatives. Embedded derivatives are required to be separated from the host contract, the 2033 Senior Notes, and carried at fair value when: (a) the embedded derivative possesses economic characteristics that are not clearly and closely related to the economic characteristics of the host contract; and (b) a separate, stand-alone instrument with the same terms would qualify as a derivative instrument. We concluded that the embedded derivatives within the 2033 Senior Notes meet these criteria and, as such, were valued separate and apart from the 2033 Senior Notes and recorded at fair value each reporting period. For accounting and financial reporting purposes, we combined these embedded derivatives and valued them together as one unit of accounting. In 2017, certain terms of the embedded derivatives expired pursuant to the original agreement and the embedded derivatives no longer met the criteria to be separated from the host contract and, as a result, the embedded derivatives were no longer required to be valued separate and apart from the 2033 Senior Notes and were reclassified to additional paid in capital. From 2013 to 2016, holders of the 2033 Senior Notes converted $143.2 million in aggregate principal amount into an aggregate of 21,539,873 shares of the Company’s Common Stock. In November 2015, BioReference and certain of its subsidiaries entered into a credit agreement with JPMorgan Chase Bank, N.A. (“CB”), as lender and administrative agent, as amended (the “Credit Agreement”). The Credit Agreement provides for a $100.0 million secured revolving credit facility and includes a $20.0 million sub-facility for swingline loans and a $20.0 million sub-facility for the issuance of letters of credit. BioReference may increase the credit facility to up to $275.0 million on a secured basis, subject to the satisfaction of specified conditions. The Credit Agreement matures on November 5, 2020 and is guaranteed by all of BioReference’s domestic subsidiaries. The Credit Agreement is also 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. Availability under the Credit Agreement is based on a borrowing base composed of eligible accounts receivables of BioReference and certain of its subsidiaries, as specified therein. As of June 30, 2019 , $1.7 million additional funds were available to be borrowed under the Credit Agreement. Principal under the Credit Agreement is due upon maturity on November 5, 2020. At BioReference’s option, borrowings under the Credit Agreement (other than swingline loans) will bear interest at (i) the CB floating rate (defined as the higher of (a) the prime rate and (b) the LIBOR rate (adjusted for statutory reserve requirements for Eurocurrency liabilities) for an interest period of one month plus 2.50% ) plus an applicable margin of 0.35% for the first 12 months and 0.50% thereafter or (ii) the LIBOR rate (adjusted for statutory reserve requirements for Eurocurrency liabilities) plus an applicable margin of 1.35% for the first 12 months and 1.50% thereafter. Swingline loans will bear interest at the CB floating rate plus the applicable margin. The Credit Agreement also calls for other customary fees and charges, including an unused commitment fee of 0.50% of the lending commitments. On August 6, 2019, BioReference and certain of its subsidiaries entered into Amendment No. 9 to the Credit Agreement, which amended certain definitions in the Credit Agreement and further amended the Credit Agreement to provide that the fixed charge coverage ratio requirement set forth in the Credit Agreement would not be tested for the second quarter and would not be tested for the quarter ending September 30, 2019, subject, in the case of testing for the quarter ending September 30, 2019, to (i) there having been no event of default occurring and (ii) availability under the revolving facility exceeding 10% of the total revolving commitment, subject to certain adjustments, for at least 30 consecutive days ending on September 30, 2019. The other terms of the Credit Agreement remain unchanged. For the quarter ended June 30, 2019, $65.1 million outstanding under the Credit Agreement was included within Other long-term liabilities. The Credit Agreement contains customary covenants and restrictions, including, without limitation, covenants that require BioReference and its subsidiaries to maintain a minimum fixed charge coverage ratio if availability under the new credit facility falls below a specified amount and to comply with laws and restrictions on the ability of BioReference and its subsidiaries to incur additional indebtedness or to pay dividends and make certain other distributions to the Company, subject to certain exceptions as specified therein. Failure to comply with these covenants would constitute an event of default under the Credit Agreement, notwithstanding the ability of BioReference to meet its debt service obligations. The Credit Agreement also includes various customary remedies for the lenders following an event of default, including the acceleration of repayment of outstanding amounts under the Credit Agreement and execution upon the collateral securing obligations under the Credit Agreement. Substantially all the assets of BioReference and its subsidiaries are restricted from sale, transfer, lease, disposal or distributions to the Company, subject to certain exceptions. BioReference and its subsidiaries net assets as of June 30, 2019 , were approximately $882.6 million , which includes goodwill of $401.8 million and intangible assets of $385.5 million . In addition to the Credit Agreement with CB, we have line of credit agreements with eleven other financial institutions as of June 30, 2019 and December 31, 2018 in the U.S., Chile and Spain. These lines of credit are used primarily as a source of working capital for inventory purchases. The following table summarizes the amounts outstanding under the BioReference, Chilean and Spanish lines of credit: (Dollars in thousands) Balance Outstanding Lender Interest rate on borrowings at June 30, 2019 Credit line capacity June 30, December 31, 2018 JPMorgan Chase 4.26% $ 100,000 $ 68,559 $ 105,198 Itau Bank 5.50% 1,810 1,287 232 Bank of Chile 6.60% 3,800 1,347 432 BICE Bank 5.50% 2,500 221 818 BBVA Bank 5.50% 3,250 472 858 Security Bank 5.50% 296 296 — Estado Bank 5.50% 3,500 1,164 308 Santander Bank 5.50% 4,500 561 852 Scotiabank 5.00% 1,800 8 2 Banco De Sabadell 1.45% 341 126 — Banco Bilbao Vizcaya 2.75% 341 — — Banco Santander 1.40% 341 — 10 Total $ 122,479 $ 74,041 $ 108,710 At June 30, 2019 and December 31, 2018 , the weighted average interest rate on our lines of credit was approximately 4.5% and 4.7% , respectively. At June 30, 2019 and December 31, 2018 , we had notes payable and other debt (excluding the 2033 Senior Notes, the 2023 Convertible Notes, the 2025 Notes, the Credit Agreement and amounts outstanding under lines of credit described above) as follows: (In thousands) June 30, December 31, 2018 Current portion of notes payable $ 2,649 $ 2,560 Other long-term liabilities 5,425 5,693 Total $ 8,074 $ 8,253 The notes and other debt mature at various dates ranging from 2019 through 2024 bearing variable interest rates from 1.3% up to 3.8% . The weighted average interest rate on the notes and other debt at June 30, 2019 and December 31, 2018 , was 2.7% and 2.1%

Accumulated Other Comprehensive

Accumulated Other Comprehensive Income (Loss)	6 Months Ended
	Jun. 30, 2019
Equity [Abstract]
ACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS)	ACCUMULATED OTHER COMPREHENSIVE INCOME (LOSS) For the six months ended June 30, 2019 , changes in Accumulated other comprehensive income (loss), net of tax, were as follows: (In thousands) Foreign currency translation Balance at December 31, 2018 $ (20,131 ) Other comprehensive loss before reclassifications (220 ) Net other comprehensive loss (220 ) Balance at June 30, 2019 $ (20,351 )

Fair Value Measurements

Fair Value Measurements	6 Months Ended
	Jun. 30, 2019
Fair Value Disclosures [Abstract]
FAIR VALUE MEASUREMENTS	FAIR VALUE MEASUREMENTS 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-tier fair value hierarchy, which prioritizes the inputs used in measuring fair value. These tiers are: Level 1, defined as observable inputs such as quoted prices in active markets; Level 2, defined as inputs other than quoted prices in active markets that are either directly or indirectly observable; and Level 3, defined as unobservable inputs in which little or no market data exists, therefore requiring an entity to develop its own assumptions. As of June 30, 2019 , we had equity securities (refer to Note 5), forward foreign currency exchange contracts for inventory purchases (refer to Note 9) and contingent consideration related to the acquisitions of CURNA, OPKO Diagnostics and OPKO Renal that are required to be measured at fair value on a recurring basis. In addition, in connection with our investment and our consulting agreement with BioCardia, we record the related BioCardia options at fair value as well as the warrants from COCP, InCellDx, Xenetic and Phio. Our financial assets and liabilities measured at fair value on a recurring basis are as follows: Fair value measurements as of June 30, 2019 (In thousands) Quoted prices in active markets for identical assets (Level 1) Significant other observable inputs (Level 2) Significant unobservable inputs (Level 3) Total Assets: Equity securities 20,856 — — 20,856 Common stock options/warrants — 488 — 488 Forward contracts — 64 — 64 Total assets $ 20,856 $ 552 $ — $ 21,408 Liabilities: Contingent consideration — — 25,568 25,568 Total liabilities $ — $ — $ 25,568 $ 25,568 Fair value measurements as of December 31, 2018 (In thousands) Quoted prices in active markets for identical assets (Level 1) Significant other observable inputs (Level 2) Significant unobservable inputs (Level 3) Total Assets: Equity securities 26,313 — — 26,313 Common stock options/warrants — 855 — 855 Forward contracts — 21 — 21 Total assets $ 26,313 $ 876 $ — $ 27,189 Liabilities: Contingent consideration — — 24,537 24,537 Total liabilities $ — $ — $ 24,537 $ 24,537 There have been no transfers between Level 1 and Level 2 and no transfers to or from Level 3 of the fair value hierarchy. As of June 30, 2019 and December 31, 2018 , the carrying value of our other financial instrument assets approximates their fair value due to their short-term nature or variable rate of interest. The following table reconciles the beginning and ending balances of our Level 3 assets and liabilities as of June 30, 2019 : June 30, 2019 (In thousands) Contingent consideration Balance at December 31, 2018 $ 24,537 Change in fair value: Included in results of operations 1,031 Balance at June 30, 2019 $ 25,568 The estimated fair values of our financial instruments have been determined by using available market information and what we believe to be appropriate valuation methodologies. We use the following methods and assumptions in estimating fair value: Contingent consideration – We estimate the fair value of the contingent consideration utilizing a discounted cash flow model for the expected payments based on estimated timing and expected revenues. We use several discount rates depending on each type of contingent consideration related to OPKO Diagnostics, CURNA and OPKO Renal transactions. If estimated future sales were to decrease by 10% , the contingent consideration related to OPKO Renal, which represents the majority of our contingent consideration liability, would decrease by $1.4 million . As of June 30, 2019 , of the $25.6 million of contingent consideration, $5.4 million is recorded in Accrued expenses and $20.2 million is recorded in Other long-term liabilities. As of December 31, 2018 , of the $24.5 million of contingent consideration, $2.4 million is recorded in Accrued expenses and $22.2 million is recorded in Other long-term liabilities.

Derivative Contracts

Derivative Contracts	6 Months Ended
	Jun. 30, 2019
Derivative Instruments and Hedging Activities Disclosure [Abstract]
DERIVATIVE CONTRACTS	DERIVATIVE CONTRACTS The following table summarizes the fair values and the presentation of our derivative assets (liabilities) in the Condensed Consolidated Balance Sheets: (In thousands) Balance Sheet Component June 30, December 31, Derivative financial instruments: Common Stock options/warrants Investments, net $ 488 $ 855 Forward contracts Unrealized gains on forward contracts are recorded in Other current assets and prepaid expenses. Unrealized (losses) on forward contracts are recorded in Accrued expenses. $ 64 $ 21 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 June 30, 2019 and December 31, 2018 , our derivative financial instruments did not meet the documentation requirements to be designated as hedges. Accordingly, we recognize the changes in Fair value of derivative instruments, net in our Condensed Consolidated Statement of Operations. The following table summarizes the losses and gains recorded for the three and six months ended June 30, 2019 and 2018: Three months ended June 30, Six months ended June 30, (In thousands) 2019 2018 2019 2018 Derivative gain (loss): Common Stock options/warrants $ (392 ) $ 1,916 $ (24 ) $ 3,587 Forward contracts 4 332 51 57 Total $ (388 ) $ 2,248 $ 27 $ 3,644

Related Party Transactions

Related Party Transactions	6 Months Ended
	Jun. 30, 2019
Related Party Transactions [Abstract]
RELATED PARTY TRANSACTIONS	RELATED PARTY TRANSACTIONS OPKO Pharmaceuticals, LLC entered into an assignment agreement with Xenetic Biosciences, Inc., as amended from time to time (the “Assignment Agreement”), pursuant to which Xenetic acquired all of OPKO Pharmaceuticals’ right, title and interest in and to that certain Intellectual Property License Agreement (the “IP License Agreement”), entered into between The Scripps Research Institute (“Institute”) and OPKO Pharmaceuticals, regarding certain patents for novel CAR T platform technology and through which the Institute granted an exclusive royalty-bearing license in exchange for royalties, subject to the terms of the IP License Agreement. Under the Assignment Agreement and the IP License Agreement, Xenetic issued to OPKO Pharmaceuticals 164,062 shares of Xenetic common stock (the “OPKO Transaction Shares”) and to the Institute 54,687 shares of Xenetic common stock (the “Institute Transaction Shares”). In connection with the Assignment Agreement, OPKO Pharmaceuticals entered into a voting agreement pursuant to which OPKO Pharmaceuticals agreed, among other things, to vote its shares in Xenetic in favor of the transactions contemplated by the Assignment Agreement, and a lock-up agreement with Xenetic which restricted OPKO Pharmaceuticals’ sale or transfer of any of the OPKO Transaction Shares as provided therein and as otherwise required by law. The Assignment Agreement and the obligations thereunder took effect on July 19, 2019, after Xenetic satisfied certain closing conditions, including obtaining stockholder approval and securing certain financing. In March 2019, we paid the $125,000 filing fee to the Federal Trade Commission (the “FTC”) in connection with filings made by us and Dr. Jane Hsiao, our Vice Chairman and Chief Technical Officer, under the Hart-Scott-Rodino Antitrust Improvements Act of 1976 (“HSR Act”) relating to her purchases of Common Stock. In February 2019, Dr. Phillip Frost, our Chairman and Chief Executive Officer, paid a filing fee of $280,000 to the FTC under the HSR Act in connection with filings made by us and Dr. Frost, relating to his purchases of Common Stock. We reimbursed Dr. Frost for the HSR filing fee. The Company owns approximately 9% of Pharmsynthez and Pharmsynthez is Xenetic’s largest and controlling stockholder. Dr. Richard Lerner, a director of the Company, is a co-inventor of the technology and received 31,240 shares of Xenetic upon the closing of the Xenetic transactions. Adam Logal, our Senior Vice President and Chief Financial Officer, is a director of Xenetic. On November 8, 2018, we entered into stock purchase agreements with certain investors pursuant to which we agreed to sell to such investors in private placements an aggregate of approximately 26.5 million shares of our Common Stock at a purchase price of $3.49 per share, which was the closing bid price of our Common Stock on the NASDAQ on such date, for an aggregate purchase price of $92.5 million . The investors in the private placements included an affiliate of Dr. Frost ( $70 million ), and Dr. Hsiao ( $2 million ). On November 8, 2018, we entered into a credit agreement with an affiliate of Dr. Frost, pursuant to which the lender committed to provide us with an unsecured line of credit in the amount of $60 million . Borrowings under the line of credit bore interest at a rate of 10% per annum and could have been repaid and reborrowed at any time. The credit agreement included various customary remedies for the lender following an event of default, including the acceleration of repayment of outstanding amounts under line of credit. The line of credit would have matured on November 8, 2023. We repaid approximately $28.8 million that was borrowed in 2019 and terminated the line of credit on or around February 20, 2019. In February 2018, we issued the 2023 Convertible Notes in the aggregate principal amount of $55.0 million . Refer to Note 6. Purchasers of the 2023 Convertible Notes included Dr. Hsiao and an affiliate of Dr. Frost. We hold investments in Zebra (ownership 29% ), Neovasc ( 5% ), ChromaDex Corporation ( 0.1% ), MabVax ( 1% ), COCP ( 8% ), NIMS ( 1% ), Eloxx ( 4% ), and BioCardia ( 5% ). These investments were considered related party transactions as a result of our executive management’s ownership interests and/or board representation in these entities. See further discussion of our investments in Note 5. In February 2018, we invested an additional $1.0 million in COCP for a convertible note, which was converted into 538,544 shares of its common stock in May 2018. In April 2017, we invested an additional $1.0 million in COCP for 138,889 shares of its common stock. In November 2017, we invested an additional $3.0 million in Neovasc for 20,547 shares of its common stock, 20,547 Series A warrants, 20,547 Series B warrants and 8,221 Series C warrants, after adjusting for a 1-for-100 reverse stock split in 2018. In April 2018, we exercised the Series B warrants in a cashless exercise and received 1,069,090 shares of Neovasc common stock. In the first quarter of 2019, we exercised the Series C warrants for $1.2 million and exchanged the Series A warrants and received a total of 2,266,023 additional shares of Neovasc common stock. In November 2016, we entered into a Pledge Agreement with the Museum of Science, Inc. and the Museum of Science Endowment Fund, Inc. pursuant to which we will contribute an aggregate of $1.0 million over a four -year period for constructing, equipping and the general operation of the Frost Science Museum. Dr. Frost and Mr. Richard Pfenniger serve on the Board of Trustees of the Frost Science Museum and Mr. Pfenniger is the Vice Chairman of the Board of Trustees. We lease office space from Frost Real Estate Holdings, LLC (“Frost Holdings”) in Miami, Florida, where our principal executive offices are located. Effective January 1, 2017, we entered into an amendment to our lease agreement with Frost Holdings. The lease, as amended, is for approximately 29,500 square feet of space. The lease provides for payments of approximately $81 thousand per month in the first year increasing annually to $86 thousand per month in the third year, plus applicable sales tax. The rent is inclusive of operating expenses, property taxes and parking. Our wholly-owned subsidiary, 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 reimburse Dr. Frost for personal use of the airplane by Dr. Frost or any other executive. For the three and six months ended June 30, 2019 , we reimbursed approximately $122 thousand and $160 thousand , respectively, for Company-related travel by Dr. Frost and other OPKO executives. For the three and six months ended June 30, 2018, we recognized approximately $61 thousand and $140 thousand

Commitments and Contingencies

Commitments and Contingencies	6 Months Ended
	Jun. 30, 2019
Commitments and Contingencies Disclosure [Abstract]
COMMITMENTS AND CONTINGENCIES	COMMITMENTS AND CONTINGENCIES In connection with our acquisitions of CURNA, OPKO Diagnostics and OPKO Renal, we agreed to pay future consideration to the sellers upon the achievement of certain events. As a result, as of June 30, 2019 , we recorded $25.6 million as contingent consideration, with $5.4 million recorded within Accrued expenses and $20.2 million recorded within Other long-term liabilities in the accompanying Condensed Consolidated Balance Sheets. Refer to Note 4. On June 3, 2019, BioReference reported that Retrieval-Masters Creditors Bureau, Inc. d/b/a American Medical Collection Agency (“AMCA”), informed the Company about a data security incident involving AMCA (the “AMCA Incident”). AMCA informed the Company that an unauthorized user had access to AMCA’s system between August 1, 2018 and March 30, 2019. AMCA advised that AMCA’s affected system may have included patient name, date of birth, address, phone, date of service, provider, and balance information. In addition, the affected AMCA system also included credit card information, bank account information (but no passwords or security questions) and email addresses that were provided by the consumer to AMCA. AMCA has advised BioReference that no Social Security Numbers were compromised, and BioReference provided no laboratory results or diagnostic information to AMCA. BioReference has begun notifying patients and provided notice to the Office of Civil Rights of the AMCA Data Security Incident. To date, BioReference has been named in two class action lawsuits against AMCA and other defendants in connection with the AMCA Incident. It is not possible at this time to estimate the amount of loss or range of loss, if any, that might result from adverse judgments, settlements, fines, penalties, or other resolution of these proceedings and investigations based on the stage of these proceedings and investigations, the absence of specific allegations as to alleged damages, the uncertainty as to the certification of a class or classes and the size of any certified class, if applicable, and/or the lack of resolution of significant factual and legal issues. As previously disclosed, on September 7, 2018, the Securities and Exchange Commission (“SEC”) filed a lawsuit in the Southern District of New York (the “SEC Complaint”) against a number of individuals and entities (the “Defendants”), including the Company and its CEO and Chairman, Dr. Phillip Frost (“Dr. Frost”). The SEC alleged, among other things, that the Company (i) aided and abetted an illegal “pump and dump” scheme perpetrated by a number of the Defendants, and (ii) failed to file required Schedules 13D or 13G with the SEC. On December 27, 2018, the Company announced that the Company and Dr. Frost entered into settlement agreements with the SEC, which upon approval of the court would resolve the SEC Complaint against each of them. The settlement was approved by the court in January 2019. Pursuant to the settlement, and without admitting or denying any of the allegations of the Complaint, the Company is enjoined from violating Section 13(d) of the Exchange Act and paid a $100,000 penalty. Liability under Section 13(d) can be established without any showing of wrongful intent or negligence. Following the SEC’s announcement of the SEC Complaint, we have been named in several class action lawsuits, more than a dozen derivative suits, and other litigation relating to the allegations in the SEC Complaint among other matters. The Company intends to vigorously defend itself against the claims. In April 2017, the Civil Division of the United States Attorney’s Office for the Southern District of New York (the “SDNY”) informed BioReference that it believes that, from 2006 to the present, BioReference had, in violation of the False Claims Act, improperly billed Medicare and TRICARE (both are federal government healthcare programs) for clinical laboratory services provided to hospital inpatient beneficiaries at certain hospitals. In April 2019, the SDNY also informed BioReference that it believes that BioReference provided physicians subsidies for electronic health record systems prior to 2012 that violated regulations adopted by HHS in 2006 which allowed laboratories to provide these donations under certain conditions. BioReference is reviewing and assessing the allegations made by the SDNY. From time to time, we may receive inquiries, document requests, Civil Investigative Demands (“CIDs”) or subpoenas from the Department of Justice, the Office of Inspector General and Office for Civil Rights (“OCR”) of the Department of Health and Human Services, the Centers for Medicare and Medicaid Services, various payors and fiscal intermediaries, and other state and federal regulators regarding investigations, audits and reviews. In addition to the matters discussed in this note, we are currently responding to CIDs, subpoenas, payor audits, and document requests for various matters relating to our laboratory operations. Some pending or threatened proceedings against us may involve potentially substantial amounts as well as the possibility of civil, criminal, or administrative fines, penalties, or other sanctions, which could be material. Settlements of suits involving the types of issues that we routinely confront may require monetary payments as well as corporate integrity agreements. Additionally, qui tam or “whistleblower” actions initiated under the civil False Claims Act may be pending but placed under seal by the court to comply with the False Claims Act’s requirements for filing such suits. Also, from time to time, we may detect issues of non-compliance with federal healthcare laws pertaining to claims submission and reimbursement practices and/or financial relationships with physicians, among other things. We may avail ourselves of various mechanisms to address these issues, including participation in voluntary disclosure protocols. Participating in voluntary disclosure protocols can have the potential for significant settlement obligations or even enforcement action. The Company generally has cooperated, and intends to continue to cooperate, with appropriate regulatory authorities as and when investigations, audits and inquiries arise. 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 could be material to our business, financial condition, results of operations, and cash flows. We expect to continue to incur substantial research and development expenses, including expenses related to the hiring of personnel and additional clinical trials. We expect that selling, general and administrative expenses will also increase as we expand our sales, marketing and administrative staff and add infrastructure, particularly as it relates to Rayaldee. We do not anticipate that we will generate substantial revenue from the sale of proprietary pharmaceutical products or certain of our diagnostic products for some time and we have generated only limited revenue from our pharmaceutical operations in Chile, Mexico, Israel, Spain, and Ireland, and from sale of the 4Kscore test. If we acquire additional assets or companies, fail to generate expected cash flow from BioReference, accelerate our product development programs or initiate additional clinical trials, we will need additional funds. If we are not able to secure additional funding when needed, we may have to delay, reduce the scope of, or eliminate one or more of our clinical trials or research and development programs or possible acquisitions. At June 30, 2019 , we were committed to make future purchases for inventory and other items in 2019 that occur in the ordinary course of business under various purchase arrangements with fixed purchase provisions aggregating approximately $69.8 million .

Revenue Recognition

Revenue Recognition	6 Months Ended
	Jun. 30, 2019
Revenue from Contract with Customer [Abstract]
REVENUE RECOGNITION	REVENUE RECOGNITION 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-party payor programs including various managed care organizations, as well as the Medicare and Medicaid programs. Billings for services are included in revenue net of allowances for contractual discounts, allowances for differences between the amounts billed and estimated program payment amounts, and implicit price concessions provided to uninsured patients which are all elements of variable consideration. The following are descriptions of our payors for laboratory services: Healthcare Insurers. Reimbursements from healthcare insurers are based on negotiated fee-for-service schedules. Revenues consist of amounts billed, net of contractual allowances for differences between amounts billed and the estimated consideration we expect to receive from such payors, which considers historical denial and collection experience and the terms of our contractual arrangements. Adjustments to the allowances, based on actual receipts from the third-party payors, are recorded upon settlement. Government Payors. Reimbursements from government payors are based on fee-for-service schedules set by governmental authorities, including traditional Medicare and Medicaid. Revenues consist of amounts billed, net of contractual allowances for differences between amounts billed and the estimated consideration we expect to receive from such payors, which considers historical denial and collection experience and the terms of our contractual arrangements. Adjustments to the allowances, based on actual receipts from the government payors, are recorded upon settlement. Client Payors. Client payors include physicians, hospitals, employers, and other institutions for which services are performed on a wholesale basis, and are billed and recognized as revenue based on negotiated fee schedules. Patients. Uninsured patients are billed based on established patient fee schedules or fees negotiated with physicians on behalf of their patients. Insured patients (including amounts for coinsurance and deductible responsibilities) are billed based on fees negotiated with healthcare insurers. Collection of billings from patients is subject to credit risk and ability of the patients to pay. Revenues consist of amounts billed net of discounts provided to uninsured patients in accordance with our policies and implicit price concessions. Implicit price concessions represent differences between amounts billed and the estimated consideration that we expect to receive from patients, which considers historical collection experience and other factors including current market conditions. Adjustments to the estimated allowances, based on actual receipts from the patients, are recorded upon settlement. The complexities and ambiguities of billing, reimbursement regulations and claims processing, as well as issues 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 six months ended June 30, 2019 and 2018, revenue reductions due to changes in estimates of implicit price concessions for performance obligations satisfied in prior periods of $14.3 million and $15.7 million , respectively, were recognized. Third-party payors, including government programs, may decide to deny payment or recoup payments for testing they contend were improperly billed or not medically necessary, against their coverage determinations, or for which they believe they have otherwise overpaid (including as a result of their own error), and we may be required to refund payments already received. Our revenues may be subject to retroactive adjustment as a result of these factors among others, including without limitation, differing interpretations of billing and coding guidance and changes by government agencies and payors in interpretations, requirements, and “conditions of participation” in various programs. We have processed requests for recoupment from third-party payors in the ordinary course of our business, and it is likely that we will continue to do so in the future. If a third-party payer denies payment for testing or recoups money from us in a later period, reimbursement for our testing could decline. 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 arise from time to time without fault on the part of the Company. We may have an obligation to reimburse Medicare, Medicaid, and third-party payors for overpayments regardless of fault. We have periodically identified and reported overpayments, reimbursed payors for overpayments and taken appropriate corrective action. Settlements with third-party payors for retroactive adjustments due to audits, reviews or investigations are also considered variable consideration and are included in the determination of the estimated transaction price for providing services. These settlements are estimated based on the terms of the payment agreement with the payor, correspondence from the payor and our historical settlement activity, including an assessment of the probability a significant reversal of cumulative revenue recognized will occur when the uncertainty is subsequently resolved. Estimated settlements are adjusted in future periods as adjustments become known (that is, new information becomes available), or as years are settled or are no longer subject to such audits, reviews, and investigations. As of June 30, 2019 and December 31, 2018 , we have liabilities of approximately $30.5 million and $35.9 million , respectively, within Accrued expenses and Other long-term liabilities related to reimbursements for payor overpayments. The composition of Revenue from services by payor for the three and six months ended June 30, 2019 and 2018 is as follows: Three months ended June 30, Six months ended June 30, (In thousands) 2019 2018 2019 2018 Healthcare insurers $ 106,278 $ 131,695 $ 211,207 $ 262,769 Government payers 28,634 38,860 59,037 75,103 Client payers 38,101 39,664 76,559 77,830 Patients 5,445 5,836 10,546 11,667 Total $ 178,458 $ 216,055 $ 357,349 $ 427,369 Revenue from products We recognize revenue from product sales when a customer obtains control of promised goods or services. The amount of revenue that is 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 increase or decrease the risk of product returns. Product revenues are recorded net of estimated rebates, chargebacks, discounts, co-pay assistance and other deductions (collectively, “Sales Deductions”), as well as estimated product returns which are all elements of variable consideration. Allowances are recorded as a reduction of revenue at the time product revenues are recognized. The actual amounts of consideration ultimately received may differ from our estimates. If actual results in the future vary from our estimates, we will adjust these estimates, which would affect Revenue from products in the period such variances become known. Rayaldee is distributed in the U.S. principally through the retail pharmacy channel, which initiates with the largest wholesalers in the U.S. (collectively, “ Rayaldee Customers”). In addition to distribution agreements with Rayaldee Customers, we have entered into arrangements with many healthcare providers and payors that provide for government-mandated and/or privately-negotiated rebates, chargebacks and discounts with respect to the purchase of Rayaldee . We recognize revenue for shipments of Rayaldee at the time of delivery to customers after estimating Sales Deductions and product returns as elements of variable consideration utilizing historical information and market research projections. For the three and six months ended June 30, 2019 , we recognized $5.7 million and $11.5 million , respectively, in net product revenue from sales of Rayaldee . For the three and six months ended June 30, 2018 , we recognized $4.8 million and $8.5 million , respectively, in net product revenue from sales of Rayaldee . The following table presents an analysis of product sales allowances and accruals as contract liabilities for the six months ended June 30, 2019 : (In thousands) Chargebacks, discounts, rebates and fees Governmental Returns Total Balance at December 31, 2018 $ 1,316 $ 2,090 $ 637 $ 4,043 Provision related to current period sales 4,716 9,791 1,380 15,887 Adjustment related to prior period sales (9 ) 211 — 202 Credits or payments made (4,611 ) (8,264 ) (1,169 ) (14,044 ) Balance at June 30, 2019 $ 1,412 $ 3,828 $ 848 $ 6,088 Total gross Rayaldee sales $ 27,580 Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales 58 % Taxes collected from customers related to revenues from services and revenues from products are excluded from revenues. Revenue from intellectual property 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 or more of the following: non-refundable, up-front license fees; development and commercialization milestone payments; funding of research and/or development activities; and royalties on sales of licensed products. Revenue is recognized upon satisfaction of a performance obligation by transferring control of a good or service to the customer. For research, development and/or commercialization agreements that result in revenues, we identify all material performance obligations, which may include a license to intellectual property and know-how, and research and development activities. In order to determine the transaction price, in addition to any upfront payment, we estimate the amount of variable consideration at the outset of the contract either utilizing the expected value or most likely amount method, depending on the facts and circumstances relative to the contract. We constrain (reduce) our estimates of variable consideration such that it is probable that a significant reversal of previously recognized revenue will not occur throughout the life of the contract. When determining if variable consideration should be constrained, we consider whether there are factors outside of our control that could result in a significant reversal of revenue. In making these assessments, we consider the likelihood and magnitude of a potential reversal of revenue. These estimates are re-assessed each reporting period as required. 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 distinct from other obligations identified in the arrangement, we utilize judgment to assess the nature of the combined performance obligation to determine whether the combined performance obligation is satisfied over time or at a point in time. If the combined performance obligation is satisfied over time, we apply an appropriate method of measuring progress for purposes of recognizing revenue from nonrefundable, upfront license fees. We evaluate the measure of progress each reporting period and, if necessary, adjust the measure of performance and related revenue recognition. Development and Regulatory Milestone Payments: Depending on facts and circumstances, we may conclude that it is appropriate to include the milestone in the estimated transaction price or that it is appropriate to fully constrain the milestone. A milestone payment is included in the transaction price in the reporting period that we conclude that it is probable that recording revenue in the period will not result in a significant reversal in amounts recognized in future periods. We may record revenues from certain milestones in a reporting period before the milestone is achieved if we conclude that achievement of the milestone is probable and that recognition of revenue related to the milestone will not result in a significant reversal in amounts recognized in future periods. We record a corresponding contract asset when this conclusion is reached. Milestone payments that have been fully constrained are not included in the transaction price to date. These milestones remain fully constrained until we conclude that achievement of the milestone is probable and that recognition of revenue related to the milestone will not result in a significant reversal in amounts recognized in future periods. We re-evaluate the probability of achievement of such development milestones and any related constraint each reporting period. We adjust our estimate of the overall transaction price, including the amount of revenue recorded, if necessary. 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. Sales-based Milestone and Royalty Payments: Our customers may be required to pay us sales-based milestone payments or royalties on future sales of commercial products. We recognize revenues related to sales-based milestone and royalty payments upon the later to occur of (i) achievement of the customer’s underlying sales or (ii) satisfaction of any performance obligation(s) related to these sales, in each case assuming the license to our intellectual property is deemed to be the predominant item to which the sales-based milestones and/or royalties relate. Other Potential Products and Services: Arrangements may include an option for license rights, future supply of drug substance or drug product for either clinical development or commercial supply at the licensee’s election. We assess if these options provide a material right to the licensee and if so, they are accounted for as separate performance obligations at the inception of the contract and revenue is recognized only if the option is exercised and products or services are subsequently delivered or when the rights expire. If the promise is based on market terms and not considered a material right, the option is accounted for if and when exercised. If we are entitled to additional payments when the licensee exercises these options, any additional payments are generally recorded in license or other revenues when the licensee obtains control of the goods, which is upon delivery. For the three and six months ended June 30, 2019 , revenue from transfer of intellectual property principally reflects $18.2 million and $35.6 million of revenue, respectively, related to the Pfizer Transaction. For the three and six months ended June 30, 2018, revenue from transfer of intellectual property principally reflects $16.3 million and $31.0 million of revenue, respectively related to the Pfizer Transaction. Refer to Note 13. Total contract liabilities included in Accrued expenses and Other long-term liabilities was $54.1 million and $91.1 million at June 30, 2019 and December 31, 2018 , respectively. The contract liability balance at June 30, 2019

Strategic Alliances

Strategic Alliances	6 Months Ended
	Jun. 30, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
STRATEGIC ALLIANCES	STRATEGIC ALLIANCES Japan Tobacco Inc. On October 12, 2017, EirGen, our wholly-owned subsidiary, and Japan Tobacco Inc. (“JT”) entered into a Development and License Agreement (the “JT Agreement”) granting JT the exclusive rights for the development and commercialization of Rayaldee in Japan (the “JT Territory”). The license grant to JT covers the therapeutic and preventative use of the product for (i) SHPT in non-dialysis and dialysis patients with CKD, (ii) rickets, and (iii) osteomalacia (the “JT Initial Indications”), as well as such additional indications as may be added to the scope of the license subject to the terms of the JT Agreement (the JT Additional Indications” and together with the JT Initial Indications, the “JT Field”). In connection with the license, OPKO received an initial upfront payment of $6 million and received another $6 million upon the initiation of OPKO’s Phase 2 study for Rayaldee in dialysis patients in the U.S. in September 2018 (the “Initial Consideration”). OPKO is also eligible to receive up to an additional aggregate amount of $31 million upon the achievement of certain regulatory and development milestones by JT for Rayaldee in the JT Territory, and $75 million upon the achievement of certain sales based milestones by JT in the JT Territory. OPKO will also receive tiered, double digit royalty payments at rates ranging from low double digits to mid-teens on net sales of Rayaldee within the JT Territory. JT will, at its sole cost and expense, be responsible for performing all development activities necessary to obtain all regulatory approvals for Rayaldee in Japan and for all commercial activities pertaining to Rayaldee in Japan. The JT Agreement provides for the following: (1) an exclusive license in the JT Territory in the JT Field for the development and commercialization of Rayaldee ; and (2) at JT’s option, EirGen will supply products to support the development, sale and commercialization of the products to JT in the JT Territory. The Initial Consideration will be recognized over the performance period through 2021, when we anticipate completing the transfer of license materials specified in the JT Agreement and our performance obligation is complete. Payments received for regulatory, development and sales milestones are non-refundable. The milestones are payable if and when the associated milestone is achieved and 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, no revenue has been recognized related to these milestones. Vifor Fresenius Medical Care Renal Pharma Ltd In May 2016, EirGen, our wholly-owned subsidiary, and Vifor Fresenius Medical Care Renal Pharma Ltd (“VFMCRP”), entered into a Development and License Agreement (the “VFMCRP Agreement”) for the development and commercialization of Rayaldee (the “Product”) worldwide, except for (i) the U.S., (ii) any country in Central America or South America (excluding Mexico), (iii) Russia, (iv) China, (v) Japan, (vi) Ukraine, (vii) Belorussia, (viii) Azerbaijan, (ix) Kazakhstan, and (x) Taiwan (the “VFMCRP Territory”). The license to VFMCRP potentially covers all therapeutic and prophylactic uses of the Product in human patients (the “VFMCRP Field”), provided that initially the license is for the use of the Product for the treatment or prevention of SHPT related to patients with CKD and vitamin D insufficiency/deficiency (the “VFMCRP Initial Indication”). Under the terms of the VFMCRP Agreement, EirGen granted to VFMCRP an exclusive license in the VFMCRP Territory in the VFMCRP Field to use certain EirGen patents and technology to make, have made, use, sell, offer for sale, and import Products and to develop, commercialize, have commercialized, and otherwise exploit the Product. EirGen received a non-refundable and non-creditable initial payment of $50 million , which was recognized in Revenue from the transfer of intellectual property and other in our Condensed Consolidated Statement of Operations in 2016. EirGen also received a $2.0 million payment triggered by the approval of Rayaldee in Canada for the treatment of SHPT in adults with stage 3 or 4 CKD and vitamin D insufficiency in July 2018. EirGen is also eligible to receive up to an additional $35 million in regulatory milestones (“Regulatory Milestones”) and $195 million in launch and sales-based milestones (“Sales Milestones”), and will receive tiered royalties on sales of the product at percentage rates that range from the mid-teens to the mid-twenties or a minimum royalty, whichever is greater, upon the commencement of sales of the Product within the VFMCRP Territory and in the VFMCRP Field. 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 of the clinical studies provided for in the development activities commenced in 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 will 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 exercised its option. 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, we entered into an exclusive worldwide agreement (the “Pfizer Agreement”) with Pfizer Inc. (“Pfizer”) for the development and commercialization of our long-acting hGH-CTP for the treatment of growth hormone deficiency (“GHD”) in adults and children, as well as for the treatment of growth failure in children born small for gestational age (the “Pfizer Transaction”). The Pfizer Transaction closed in January 2015. Under the terms of the Pfizer Transaction, 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 hGH-CTP worldwide. In addition, we are eligible to receive initial tiered royalty payments associated with the commercialization of hGH-CTP for Adult GHD with percentage rates ranging from the high teens to mid-twenties. Upon the launch of hGH-CTP for Pediatric GHD in certain major markets, the royalties will transition to regional, tiered gross profit sharing for both hGH-CTP and Pfizer’s Genotropin®. The agreement with Pfizer will remain in effect until the last sale of the licensed product, unless earlier terminated as permitted under the Pfizer Agreement. In addition to termination rights for material breach and bankruptcy, Pfizer is permitted to terminate the Pfizer Agreement in its entirety, or with respect to one or more world regions, without cause after a specified notice period. If the Pfizer Agreement is terminated by us for Pfizer’s uncured material breach, or by Pfizer without cause, provision has been made for transition of product and product responsibilities to us for the terminated regions, as well as continued supply of product by Pfizer or transfer of supply to us in order to support the terminated regions. We are recognizing the non-refundable $295.0 million upfront payments as revenue as the research and development services are completed and had contract liabilities related to the Pfizer Transaction of $47.5 million at June 30, 2019 , which was classified in Accrued expenses. The Pfizer Transaction 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, no revenue has been recognized related to the achievement of the milestones. TESARO In November 2009, we entered into an asset purchase agreement (the “NK-1 Agreement”) under which we acquired VARUBI™ (rolapitant) and other neurokinin-1 (“NK-1”) assets from Merck. In December 2010, we entered into an exclusive license agreement with TESARO, in which we out-licensed the development, manufacture, commercialization and distribution of our lead NK-1 candidate, VARUBI™ (the “TESARO License”). Under the terms of the license, we received a $6.0 million upfront payment from TESARO and we received $30 million of milestone payments from TESARO upon achievement of certain regulatory and commercial sale milestones and we are eligible to receive additional commercial milestone payments of up to $85 million if specified levels of annual net sales are achieved. The sales based milestone payments will be recognized as revenue in full in the period in which the associated sales occur. During the six months ended June 30, 2019 and 2018, no revenue was recognized related to the achievement of the milestones under the TESARO License. TESARO is also obligated to pay us tiered royalties on annual net sales achieved in the U.S. and Europe at percentage rates that range from the low double digits to the low twenties, and outside of the U.S. and Europe at low double-digit percentage rates. Royalties will be recognized in the period the sales occur. TESARO assumed responsibility for clinical development and commercialization of licensed products at its expense. Under the NK-1 Agreement, we will continue to receive royalties on a country-by-country and product-by-product basis until the later of the date that all of the patent rights licensed from us and covering VARUBI™ expire, are invalidated or are not enforceable and 12 years from the first commercial sale of the product. If TESARO elects to develop and commercialize VARUBI™ in Japan through a third-party licensee, TESARO will share equally with us all amounts it receives in connection with such activities, subject to certain exceptions and deductions. The term of the license will remain in force until the expiration of the royalty term in each country, unless we terminate the license earlier for TESARO’s material breach of the license or bankruptcy. TESARO has a right to terminate the license at any time during the term for any reason on three months’ written notice. TESARO announced during the first quarter of 2018 that it has elected to suspend further distribution of Varubi IV. TESARO assigned its rights and obligations under the agreement to TerSera Therapeutics LLC (“TerSera”) in June 2018 pursuant to an asset purchase agreement. Under the asset purchase agreement, TerSera is responsible for VARUBI in the U.S. and Canada and TESARO can continue to commercialize VARUBY® in Europe and the rest of the world though a sublicense with TerSera. Pharmsynthez In April 2013, we entered into a series of concurrent transactions with Pharmsynthez, a Russian pharmaceutical company traded on the Moscow Stock Exchange, pursuant to which we acquired an equity method investment in Pharmsynthez (ownership 9% ). We also granted rights to certain technologies in the Russian Federation, Ukraine, Belarus, Azerbaijan and Kazakhstan (the “Pharmsynthez Territories”) to Pharmsynthez and agreed to perform certain development activities. We will receive from Pharmsynthez royalties on net sales of products incorporating the technologies in the Pharmsynthez Territories, as well as a percentage of any sublicense income from third parties for the technologies in the Pharmsynthez Territories. Phio Pharmaceuticals Corp. In March 2013, we completed the sale to RXi Pharmaceuticals Corporation (now known as Phio Pharmaceuticals Corp.) of substantially all of our assets in the field of RNA interference (the “RNAi Assets”) (collectively, the “Asset Purchase Agreement”). Pursuant to the Asset Purchase Agreement, Phio will be required to pay us up to $50.0 million in milestone payments upon the successful development and commercialization of each drug developed by Phio, certain of its affiliates or any of its or their licensees or sublicensees utilizing patents included within the RNAi Assets (each, a “Qualified Drug”). In addition, Phio will also be required to pay us royalties equal to: (a) a mid single-digit percentage of “Net Sales” (as defined in the Asset Purchase Agreement) with respect to each Qualified Drug sold for an ophthalmologic use during the applicable “Royalty Period” (as defined in the Asset Purchase Agreement); and (b) a low single-digit percentage of net sales with respect to each Qualified Drug sold for a non-ophthalmologic use during the applicable Royalty Period. 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.

Segments

Segments	6 Months Ended
	Jun. 30, 2019
Segment Reporting [Abstract]
SEGMENTS	SEGMENTS We manage our operations in two reportable segments, pharmaceutical and diagnostics. The pharmaceutical segment consists of our pharmaceutical operations in Chile, Mexico, Ireland, Israel and Spain, Rayaldee product sales and our pharmaceutical research and development. The diagnostics segment primarily consists of our clinical laboratory operations through BioReference and our point-of-care operations. There are no significant inter-segment sales. We evaluate the performance of each segment based on operating profit or loss. There is no inter-segment allocation of interest expense and income taxes. 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 June 30, For the six months ended June 30, (In thousands) 2019 2018 2019 2018 Revenue from services: Pharmaceutical $ — $ — $ — $ — Diagnostics 178,458 216,055 357,349 427,369 Corporate — — — — $ 178,458 $ 216,055 $ 357,349 $ 427,369 Revenue from products: Pharmaceutical $ 28,680 $ 28,523 $ 53,981 $ 56,374 Diagnostics — — — — Corporate — — — — $ 28,680 $ 28,523 $ 53,981 $ 56,374 Revenue from transfer of intellectual property and other: Pharmaceutical $ 19,230 $ 19,107 $ 37,490 $ 34,855 Diagnostics — — — — Corporate — — — — $ 19,230 $ 19,107 $ 37,490 $ 34,855 Operating loss: Pharmaceutical $ (8,556 ) $ 2,165 $ (38,033 ) $ (20,783 ) Diagnostics (28,013 ) 1,475 (61,582 ) (6,543 ) Corporate (10,691 ) (8,748 ) (22,962 ) (20,393 ) $ (47,260 ) $ (5,108 ) $ (122,577 ) $ (47,719 ) Depreciation and amortization: Pharmaceutical $ 7,382 $ 6,752 $ 14,908 $ 13,492 Diagnostics 16,260 17,989 32,530 35,975 Corporate 19 21 39 51 $ 23,661 $ 24,762 $ 47,477 $ 49,518 Loss from investment in investees: Pharmaceutical $ (271 ) $ (6,942 ) $ (2,125 ) $ (9,114 ) Diagnostics — (271 ) — (555 ) Corporate — — — — $ (271 ) $ (7,213 ) $ (2,125 ) $ (9,669 ) Revenues: United States $ 184,310 $ 222,535 $ 369,203 $ 437,845 Ireland 22,174 20,778 42,707 38,060 Chile 9,051 11,937 16,915 23,670 Spain 4,876 4,592 9,294 10,125 Israel 3,768 2,526 6,884 6,141 Mexico 2,058 1,302 3,589 2,723 Other 131 15 228 34 $ 226,368 $ 263,685 $ 448,820 $ 518,598 (In thousands) June 30, December 31, Assets: Pharmaceutical $ 1,239,338 $ 1,236,499 Diagnostics 1,138,673 1,162,160 Corporate 78,217 52,413 $ 2,456,228 $ 2,451,072 Goodwill: Pharmaceutical $ 247,055 $ 247,407 Diagnostics 452,787 452,786 Corporate — — $ 699,842 $ 700,193 No customer represented more than 10% of our total consolidated revenue during the three and six months ended June 30, 2019 and 2018. As of June 30, 2019 and December 31, 2018 , no customer represented more than 10%

Leases

Leases	6 Months Ended
	Jun. 30, 2019
Leases [Abstract]
LEASES	LEASES 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 provide an implicit rate, and therefore we use our incremental borrowing rate as the discount rate when measuring operating lease liabilities. The incremental borrowing rate represents an estimate of the interest rate we would incur at lease commencement to borrow an amount equal to the lease payments on a collateralized basis over the term of the lease within a particular currency environment. We used the incremental borrowing rates as of January 1, 2019, for operating leases that commenced prior to that date. Many of our leases contain rental escalation, renewal options and/or termination options that are factored into our determination of lease payments when appropriate. Variable lease payment amounts that cannot be determined at the commencement of the lease are not included in the right-to-use assets or liabilities. The following table presents the lease balances within the Condensed Consolidated Balance Sheet as of June 30, 2019: (in thousands) Classification on the Balance Sheet June 30, 2019 Assets Operating lease assets Operating lease right-of-use assets $ 29,640 Finance lease assets Property, plant and equipment, net 7,681 Liabilities Current Operating lease liabilities Current maturities of operating leases 13,376 Accrued expenses Current maturities of finance leases 3,031 Long-term Operating lease liabilities Operating lease liabilities 16,673 Other long-term liabilities Finance lease liabilities $ 4,650 Weighted average remaining lease term Operating leases 2.1 years Finance leases 2.5 years Weighted average discount rate Operating leases 4.3 % Finance leases 4.5 % 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 year to the total operating lease liabilities recognized on our Condensed Consolidated Balance Sheet as of June 30, 2019: (in thousands) Operating Finance July 1, 2019 through December 31, 2019 $ 7,968 $ 1,661 2020 10,169 2,649 2021 6,678 1,938 2022 3,754 960 2023 2,329 368 Thereafter 2,096 419 Total undiscounted future minimum lease payments 32,994 7,995 Less: Difference between lease payments and discounted lease liabilities 2,945 314 Total lease liabilities $ 30,049 $ 7,681 Expense under operating leases and finance leases was $9.8 million and $2.0 million , respectively, for the six months ended June 30, 2019 , and includes $1.7 million of variable lease costs. Operating lease costs and finance lease costs are included within Operating loss in the Condensed Consolidated Statement of Operations. Short-term lease costs and were not material. Supplemental cash flow information is as follows: (in thousands) Six months ended June 30, 2019 Operating cash flows from operating leases $ 10,804 Operating cash flows from finance leases 234 Financing cash flows from finance leases 1,590 Total $ 12,628

Subsequent Events

Subsequent Events	6 Months Ended
	Jun. 30, 2019
Subsequent Events [Abstract]
SUBSEQUENT EVENTS	SUBSEQUENT EVENTS On August 6, 2019, BioReference and certain of its subsidiaries entered into Amendment No. 9 to the Credit Agreement, which amended certain definitions in the Credit Agreement and further amended the Credit Agreement to provide that the fixed charge coverage ratio requirement set forth in the Credit Agreement would not be tested for the second quarter and would not be tested for the quarter ending September 30, 2019, subject, in the case of testing for the quarter ending September 30, 2019, to (i) there having been no event of default occurring and (ii) availability under the revolving facility exceeding 10% of the total revolving commitment, subject to certain adjustments, for at least 30 consecutive days ending on September 30, 2019. The other terms of the Credit Agreement remain unchanged. We have reviewed all subsequent events and transactions that occurred after the date of our June 30, 2019 Condensed Consolidated Balance Sheet date, through the time of filing this Quarterly Report on Form 10-Q.

Summary of Significant Accoun_2

Summary of Significant Accounting Policies (Policies)	6 Months Ended
	Jun. 30, 2019
Accounting Policies [Abstract]
Basis of presentation	Basis of presentation . The accompanying unaudited Condensed Consolidated Financial Statements have been prepared in accordance with accounting principles generally accepted in the U.S. (“GAAP”) and with the instructions to Form 10-Q and Article 10 of Regulation S-X. Accordingly, they do not include all information and notes required by GAAP for complete financial statements. In the opinion of management, all adjustments (consisting of only normal recurring adjustments or otherwise disclosed herein) considered necessary to present fairly the Company’s results of operations, financial position and cash flows have been made. The results of operations and cash flows for the three and six months ended June 30, 2019 are not necessarily indicative of the results of operations and cash flows that may be reported for the remainder of 2019 or any other future periods. The unaudited Condensed Consolidated Financial Statements should be read in conjunction with the audited Consolidated Financial Statements and the Notes to Consolidated Financial Statements included in our Annual Report on Form 10-K for the year ended December 31, 2018
Principles of consolidation	Principles of consolidation
Use of estimates	Use of estimates . The preparation of financial statements in conformity with GAAP requires management to make estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of the financial statements and the reported amounts of revenues and expenses during the reporting period. Actual results could differ significantly from these estimates.
Cash and cash equivalents	Cash and cash equivalents . Cash and cash equivalents include short-term, interest-bearing instruments with original maturities of 90 days or less at the date of purchase. We also consider all highly liquid investments with original maturities at the date of purchase of 90 days
Inventories	Inventories . Inventories are valued at the lower of cost and net realizable value. Cost is determined by the first-in, first-out method. We consider such factors as the amount of inventory on hand, estimated time required to sell such inventories, remaining shelf-life, and current market conditions to determine whether inventories are stated at the lower of cost and net realizable value. Inventories at our diagnostics segment consist primarily of purchased laboratory supplies, which is used in our testing laboratories. Inventory obsolescence expense for the six months ended June 30, 2019 and 2018 was $1.3 million and $1.2 million , respectively. Pre-launch inventories
Goodwill and intangible assets	Goodwill and intangible assets . Goodwill represents the difference between the purchase price and the estimated fair value of the net assets acquired accounted for by the acquisition method of accounting. Refer to Note 4. Goodwill, in-process research and development (“IPR&D”) and other intangible assets acquired in business combinations, licensing and other transactions at June 30, 2019 and December 31, 2018 was $1.9 billion and $2.0 billion , respectively. 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. We determined the fair value of intangible assets, including IPR&D, using the “income method.” Goodwill is tested at least annually for impairment, or when events or changes in circumstances indicate that the carrying amount of such assets may not be recoverable, by assessing qualitative factors or performing a quantitative analysis in determining whether it is more likely than not that its fair value exceeds the carrying value. Estimating the fair value of a reporting unit for goodwill impairment is highly sensitive to changes in projections and assumptions; therefore, in some instances, changes in these 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, future potential changes in these assumptions may impact the estimated fair value of a reporting unit and cause the fair value of the reporting unit to be below its carrying value. We believe that our estimates are consistent with assumptions that marketplace participants would use in their estimates of fair value. However, if actual results are not consistent with our estimates and assumptions, we may be exposed to an impairment charge that could be material. For the three and six months periods ending June 30, 2019, the results of operations of our BioReference reporting unit were below management’s forecast of expected cash flows due to a change in reimbursement coverage for our 4Kscore test and other market factors. If we are unable to obtain appropriate reimbursement for our 4Kscore test and experience sustained declines in operating results versus forecast, our estimates of the fair value of the BioReference reporting unit may change. If the fair value of the reporting unit falls below carrying value, we would record impairment of goodwill at BioReference and such impairment could be significant. Intangible assets are tested for impairment whenever events or changes in circumstances indicate that the carrying amount of such assets may not be recoverable, although IPR&D is required to be tested at least annually until the project is completed or abandoned. Upon obtaining regulatory approval, the IPR&D asset is then accounted for as a finite-lived intangible asset and amortized on a straight-line basis over its estimated useful life. If the project is abandoned, the IPR&D asset is charged to expense. The cost and duration of the development project for hGH-CTP have exceeded our original estimates and will result in additional expenses beyond our estimates and the agreed development cap. If we are unable to reach an agreement with Pfizer regarding cost sharing for overruns, as well as other obligations, including development obligations, it could have a material adverse impact on the expected benefits of the Pfizer transaction. If we are unable to successfully develop hGH-CTP, or if changes in projections and assumptions negatively impact our forecast of net cash flows, then we may be exposed to a material impairment charge related to the IPR&D for hGH-CTP. We amortize intangible assets with definite lives on a straight-line basis over their estimated useful lives, ranging from 3 to 20
Fair value measurements	Fair value measurements . The carrying amounts of our cash and cash equivalents, accounts receivable, accounts payable and short-term debt approximate their fair value due to the short-term maturities of these instruments. Investments that are considered equity securities as of June 30, 2019 and December 31, 2018 are predominately carried at fair value. Our debt under our credit agreement with JPMorgan Chase Bank, N.A. approximates fair value due to the variable rate of interest.
Contingent consideration	Contingent consideration . Each period we revalue the contingent consideration obligations associated with certain prior acquisitions to their fair value and record increases in the fair value as contingent consideration expense and decreases in the fair value as a reduction in contingent consideration expense. Changes in contingent consideration result from changes in the assumptions regarding probabilities of successful achievement of related milestones, the estimated timing in which the milestones are achieved and the discount rate used to estimate the fair value of the liability. Contingent consideration may change significantly as our development programs progress, revenue estimates evolve and additional data is obtained, impacting our assumptions. The assumptions used in estimating fair value require significant judgment. The use of different assumptions and judgments could result in a materially different estimate of fair value which may have a material impact on our results from operations and financial position.
Derivative financial instruments	Derivative financial instruments . We record derivative financial instruments on our Condensed Consolidated Balance Sheet at their fair value and recognize the changes in the fair value in our Condensed Consolidated Statement of Operations when they occur, the only exception being derivatives that qualify as hedges. For the derivative instrument to qualify 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 June 30, 2019 and December 31, 2018
Property, plant and equipment	Property, plant and equipment . Property, plant and equipment are recorded at cost. Depreciation is provided using the straight-line method over the estimated useful lives of the assets and includes amortization expense for assets capitalized under finance leases. The estimated useful lives by asset class are as follows: software - 3 years, machinery, medical and other equipment - 5 - 8 years, furniture and fixtures - 5 - 12 years, leasehold improvements - the lesser of their useful life or the lease term, buildings and improvements - 10 - 40 years, and automobiles - 3 - 5 years. Expenditures for repairs and maintenance are charged to expense as incurred. Depreciation expense was $14.5 million and $15.0 million for the six months ended June 30, 2019 and 2018, respectively. Assets held under finance leases are included within Property, plant and equipment, net in our Condensed Consolidated Balance Sheet and are amortized over the shorter of their useful lives or the expected term of their related leases.
Impairment of long-lived assets	Impairment of long-lived assets. Long-lived assets, such as property and equipment, are reviewed for impairment whenever events or changes in circumstances indicate that the carrying amount of an asset may not be recoverable. Recoverability of assets to be held and used is measured by a comparison of the carrying amount of an asset to estimated undiscounted future cash flows expected to be generated by the asset. If the carrying amount of an asset exceeds its estimated future cash flows, then an impairment charge is recognized for the amount by which the carrying amount of the asset exceeds the fair value of the asset.
Income taxes	Income taxes. Income taxes are accounted for under the asset-and-liability method. Deferred tax assets and liabilities are recognized for the future tax consequences attributable to differences between the financial statement carrying amounts of existing assets and liabilities and the respective tax bases and for operating loss and tax credit carryforwards. Deferred tax assets and liabilities are measured using enacted tax rates expected to apply to taxable income in the years in which those temporary differences are expected to be recovered or settled. The effect on deferred tax assets and liabilities of a change in tax rates is recognized in operations in the period that includes the enactment date. We periodically evaluate the realizability of our net deferred tax assets. Our tax accruals are analyzed periodically and adjustments are made as events occur to warrant such adjustment. Valuation allowances on certain U.S. deferred tax assets and non-U.S. deferred tax assets are established, because realization of these tax benefits through future taxable income does not meet the more-likely-than-not threshold. 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 three and six months ended June 30, 2019 , the tax rate differed from the U.S. federal statutory rate of 21% primarily due to the valuation allowance against certain U.S. and non-U.S. deferred tax assets, the relative mix in earnings and losses in the U.S. versus foreign tax jurisdictions, and the impact of certain discrete tax events and operating results in tax jurisdictions which do not result in a tax benefit.
Revenue recognition and shipping and handling costs	Shipping and handling costs. We do not charge customers for shipping and handling costs. Shipping and handling costs are classified as Cost of revenues in the Condensed Consolidated Statement of Operations. Revenue recognition . We recognize revenue when a customer obtains control of promised goods or services in accordance with Accounting Standards Codification Topic 606, Revenue from Contracts with Customers (“Topic 606”). The amount of revenue that is recorded reflects the consideration that we expect to receive in exchange for those goods or services. We apply the following five-step model in order to determine this amount: (i) identify the contract(s) with a customer; (ii) identify the performance obligations in the contract; (iii) determine the transaction price; (iv) allocate the transaction price to the performance obligations in the contract; and (v) recognize revenue when (or as) we satisfy a performance obligation.
Concentration of credit risk	Concentration of credit risk and allowance for doubtful accounts . Financial instruments that potentially subject us to concentrations of credit risk consist primarily of accounts receivable. Substantially all of our accounts receivable are with either companies in the healthcare industry or patients. However, credit risk is limited due to the number of our clients as well as their dispersion across many different geographic regions.
Allowance for doubtful accounts	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 affect a customer’s ability to pay. Actual results could differ from those estimates. Our reported net loss is directly affected by our estimate of the collectability of accounts receivable.
Equity-based compensation	Equity-based compensation
Research and development expenses	Research and development expenses. Research and development expenses include external and internal expenses. External expenses include clinical and non-clinical activities performed by contract research organizations, lab services, purchases of drug and diagnostic product materials and manufacturing development costs. Research and development employee-related expenses include salaries, benefits and equity-based compensation expense. Other internal research and development expenses are incurred to support overall research and development activities and include expenses related to general overhead and facilities. We expense these costs in the period in which they are incurred. We estimate our liabilities for research and development expenses in order to match the recognition of expenses to the period in which the actual services are received. As such, accrued liabilities related to third party research and development activities are recognized based upon our estimate of services received and degree of completion of the services in accordance with the specific third party contract. Research and development expense includes costs for in-process research and development projects acquired in asset acquisitions which have not reached technological feasibility and which have no alternative future use. For in-process research and development projects acquired in business combinations, the in-process research and development project is capitalized and evaluated for impairment until the development process has been completed. Once the development process has been completed the asset will be amortized over its remaining useful life.
Segment reporting	Segment reporting . Our chief operating decision-maker (“CODM”) is Phillip Frost, M.D., our Chairman and Chief Executive Officer. Our CODM reviews our operating results and operating plans and makes resource allocation decisions on a Company-wide or aggregate basis. We manage our operations in two reportable segments, pharmaceutical and diagnostics. The pharmaceutical segment consists of our pharmaceutical operations in Chile, Mexico, Ireland, Israel and Spain, Rayaldee
Foreign currency translation	Foreign currency translation . The financial statements of certain of our foreign operations are measured using the local currency as the functional currency. The local currency assets and liabilities are generally translated at the rate of exchange to the U.S. dollar on the balance sheet date and the local currency revenues and expenses are translated at average rates of exchange to the U.S. dollar during the reporting periods. Foreign currency transaction gains (losses) have been reflected as a component of Other income (expense), net within the Condensed Consolidated Statement of Operations and foreign currency translation gains (losses) have been included as a component of the Condensed Consolidated Statement of Comprehensive Loss.
Variable interest entities	Variable interest entities
Investments	Investments
Accounting pronouncements	Recently adopted accounting pronouncements . In February 2016, the Financial Accounting Standards Board ("FASB") issued Accounting Standards Update ("ASU") No. 2016-02, “Leases (Topic 842),” which requires organizations that lease assets with lease terms of more than 12 months to recognize assets and liabilities for the rights and obligations created by those leases on their balance sheets. ASU 2016-02, as amended and codified under Topic 842, requires new qualitative and quantitative disclosures to help investors and other financial statement users better understand the amount, timing, and uncertainty of cash flows arising from leases. As required, we adopted Topic 842 on January 1, 2019 using the modified retrospective approach for all lease arrangements at the beginning or the period of adoption. Results for reporting periods beginning January 1, 2019 are presented under Topic 842, while prior period amounts were not adjusted and continue to be reported in accordance our historic accounting under ASC 840. For leases that commenced before the effective date of Topic 842, we elected the permitted practical expedients to not reassess the following: (i) whether any expired or existing contracts contain leases (ii) the lease classification for any expired or existing leases and (iii) initial direct costs for any existing leases. We also elected the policy of not recording leases on our Condensed Consolidated Balance Sheet when the leases have a term of 12 months or less and we elected not to separate nonlease components from lease components and instead account for each separate lease component and the nonlease components associated with that lease component as a single lease component. The adoption of Topic 842 resulted in the recognition of operating lease liabilities of approximately $33.7 million and operating lease right-to-use assets of approximately $33.3 million as of March 31, 2019, primarily related to operating leases for our diagnostic facilities, based on the present value of lease payments over the lease term. There was no cumulative-effect adjustment to beginning Accumulated deficit on the Condensed Consolidated Balance Sheet. The accounting for our finance leases remains substantially unchanged, as finance lease liabilities and their corresponding right-to-use assets were already recorded on the Condensed Consolidated Balance Sheet under the previous guidance. The adoption of Topic 842 did not have a significant effect on our results of operations or cash flows. Refer to Note 15 for additional disclosures required by Topic 842. In February 2018, the FASB issued ASU No. 2018-02, "Income Statement-Reporting Comprehensive Income (Topic 220)." This standard provides an option to reclassify stranded tax effects within accumulated other comprehensive loss to retained earnings due to the U.S. federal corporate income tax rate change in the Tax Cuts and Jobs Act of 2017. This standard is effective for interim and annual reporting periods beginning after December 15, 2018. We adopted this standard effective January 1, 2019 with the election not to reclassify immaterial amounts of stranded tax effects from accumulated other comprehensive loss to retained earnings. In June 2018, the FASB issued ASU No. 2018-07, “Compensation - Stock Compensation (Topic 718),” which expands the scope of Topic 718 to include share-based payment transactions for acquiring goods and services from non-employees. The adoption of ASU 2018-07 on January 1, 2019, did not have a significant impact on our Condensed Consolidated Financial Statements. Pending accounting pronouncements . In June 2016, the FASB issued ASU No. 2016-13, “Financial Instruments - Credit Losses (Topic 326): Measurement of Credit Losses on Financial Instruments,” which amends the impairment model by requiring entities to use a forward-looking approach based on expected losses rather than incurred losses to estimate credit losses on certain types of financial instruments, including trade receivables. This may result in the earlier recognition of allowances for losses. The The ASU is effective for public entities for fiscal years beginning after December 15, 2019, with early adoption permitted. We are currently evaluating the impact of this new guidance on our Condensed Consolidated Financial Statements.

Composition of Certain Financ_2

Composition of Certain Financial Statement Captions (Tables)	6 Months Ended
	Jun. 30, 2019
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Composition of Certain Financial Statement Captions	(In thousands) June 30, December 31, Accounts receivable, net: Accounts receivable $ 150,414 $ 145,665 Less: allowance for doubtful accounts (2,127 ) (1,758 ) $ 148,287 $ 143,907 Inventories, net: Consumable supplies $ 22,008 $ 23,264 Finished products 21,481 15,259 Work in-process 3,096 2,473 Raw materials 4,741 4,259 Less: inventory reserve (3,033 ) (2,956 ) $ 48,293 $ 42,299 Other current assets and prepaid expenses: Taxes recoverable 18,176 15,708 Other receivables 661 2,368 Prepaid supplies 10,584 9,693 Prepaid insurance 3,878 3,436 Other 3,234 3,847 $ 36,533 $ 35,052 Intangible assets, net: Customer relationships $ 446,144 $ 446,296 Technologies 340,702 340,729 Trade names 50,420 50,404 Licenses 5,766 5,766 Covenants not to compete 16,321 16,322 Product registrations 8,016 7,861 Other 5,586 5,613 Less: accumulated amortization (291,649 ) (258,539 ) $ 581,306 $ 614,452 Accrued expenses: Contract liabilities $ 50,388 $ 63,503 Employee benefits 39,453 45,621 Clinical trials 9,936 10,401 Contingent consideration 5,387 2,375 Finance leases short-term 3,031 3,280 Milestone payment 4,968 4,871 Professional fees 3,317 7,935 Other 81,902 65,527 $ 198,382 $ 203,513 (In thousands) June 30, December 31, Other long-term liabilities: Contract liabilities $ 3,665 $ 27,566 Line of credit 65,112 105,198 Contingent consideration 20,181 22,162 Mortgages and other debts payable 4,500 4,654 Finance leases long-term 4,650 5,620 Other 29,643 33,768 $ 127,751 $ 198,968
Changes in Goodwill	The following table summarizes the changes in Goodwill during the six months ended June 30, 2019 . 2019 (In thousands) Balance at January 1 Foreign exchange and other Balance at June 30th Pharmaceuticals CURNA $ 4,827 $ — $ 4,827 EirGen 85,245 (551 ) 84,694 FineTech — — — OPKO Chile 4,614 112 4,726 OPKO Biologics 139,784 — 139,784 OPKO Health Europe 7,545 (49 ) 7,496 OPKO Renal 2,069 — 2,069 Transition Therapeutics 3,323 137 3,460 Diagnostics BioReference 401,821 — 401,821 OPKO Diagnostics 17,977 — 17,977 OPKO Lab 32,988 — 32,988 $ 700,193 $ (351 ) $ 699,842

Investments (Tables)

Investments (Tables)	6 Months Ended
	Jun. 30, 2019
Business Combinations [Abstract]
Accounting Method, Carrying Value and Underlying Equity in Net Assets of Unconsolidated Investments	The following table reflects the accounting method, carrying value and underlying equity in net assets of our unconsolidated investments as of June 30, 2019 : (in thousands) Investment type Investment Carrying Value Underlying Equity in Net Assets Equity method investments $ 1,975 $ 10,616 Variable interest entity, equity method 1,010 — Equity securities 20,856 Equity securities with no readily determinable fair value 438 Warrants and options 488 Total carrying value of investments $ 24,767
Schedule of Net Gains and Losses on Equity Securities	Net gains and losses on our equity securities for the six months ended June 30, 2019 are as follows: (in thousands) Equity Securities For the six months ended June 30, 2019 Net gains and losses recognized during the period on equity securities $ (5,458 ) Less: Net gains and losses realized during the period on equity securities — Unrealized net gains recognized during the period on equity securities still held at the reporting date $ (5,458 )

Debt (Tables)

Debt (Tables)	6 Months Ended
	Jun. 30, 2019
Debt Disclosure [Abstract]
Schedule of Debt	At June 30, 2019 and December 31, 2018 , we had notes payable and other debt (excluding the 2033 Senior Notes, the 2023 Convertible Notes, the 2025 Notes, the Credit Agreement and amounts outstanding under lines of credit described above) as follows: (In thousands) June 30, December 31, 2018 Current portion of notes payable $ 2,649 $ 2,560 Other long-term liabilities 5,425 5,693 Total $ 8,074 $ 8,253 The following table sets forth information related to the 2025 Notes which is included in our Condensed Consolidated Balance Sheet as of June 30, 2019 : (In thousands) 2025 Senior Notes Discount Debt Issuance Cost Total Balance at December 31, 2018 $ — $ — $ — $ — Issuance of 4.50% convertible notes 200,000 (52,600 ) (5,720 ) 141,680 Amortization of debt discount and debt issuance costs — 2,483 269 2,752 Balance at June 30, 2019 $ 200,000 $ (50,117 ) $ (5,451 ) $ 144,432
Summary of Lines of Credit	The following table summarizes the amounts outstanding under the BioReference, Chilean and Spanish lines of credit: (Dollars in thousands) Balance Outstanding Lender Interest rate on borrowings at June 30, 2019 Credit line capacity June 30, December 31, 2018 JPMorgan Chase 4.26% $ 100,000 $ 68,559 $ 105,198 Itau Bank 5.50% 1,810 1,287 232 Bank of Chile 6.60% 3,800 1,347 432 BICE Bank 5.50% 2,500 221 818 BBVA Bank 5.50% 3,250 472 858 Security Bank 5.50% 296 296 — Estado Bank 5.50% 3,500 1,164 308 Santander Bank 5.50% 4,500 561 852 Scotiabank 5.00% 1,800 8 2 Banco De Sabadell 1.45% 341 126 — Banco Bilbao Vizcaya 2.75% 341 — — Banco Santander 1.40% 341 — 10 Total $ 122,479 $ 74,041 $ 108,710

Accumulated Other Comprehensi_2

Accumulated Other Comprehensive Income (Loss) (Tables)	6 Months Ended
	Jun. 30, 2019
Equity [Abstract]
Changes in Accumulated Other Comprehensive Income (Loss), Net of Tax	For the six months ended June 30, 2019 , changes in Accumulated other comprehensive income (loss), net of tax, were as follows: (In thousands) Foreign currency translation Balance at December 31, 2018 $ (20,131 ) Other comprehensive loss before reclassifications (220 ) Net other comprehensive loss (220 ) Balance at June 30, 2019 $ (20,351 )

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	6 Months Ended
	Jun. 30, 2019
Fair Value Disclosures [Abstract]
Financial Assets and Liabilities Measured at Fair Value on a Recurring Basis	Our financial assets and liabilities measured at fair value on a recurring basis are as follows: Fair value measurements as of June 30, 2019 (In thousands) Quoted prices in active markets for identical assets (Level 1) Significant other observable inputs (Level 2) Significant unobservable inputs (Level 3) Total Assets: Equity securities 20,856 — — 20,856 Common stock options/warrants — 488 — 488 Forward contracts — 64 — 64 Total assets $ 20,856 $ 552 $ — $ 21,408 Liabilities: Contingent consideration — — 25,568 25,568 Total liabilities $ — $ — $ 25,568 $ 25,568 Fair value measurements as of December 31, 2018 (In thousands) Quoted prices in active markets for identical assets (Level 1) Significant other observable inputs (Level 2) Significant unobservable inputs (Level 3) Total Assets: Equity securities 26,313 — — 26,313 Common stock options/warrants — 855 — 855 Forward contracts — 21 — 21 Total assets $ 26,313 $ 876 $ — $ 27,189 Liabilities: Contingent consideration — — 24,537 24,537 Total liabilities $ — $ — $ 24,537 $ 24,537
Reconciliation of the Beginning and Ending Balances of Level 3 Assets	The following table reconciles the beginning and ending balances of our Level 3 assets and liabilities as of June 30, 2019 : June 30, 2019 (In thousands) Contingent consideration Balance at December 31, 2018 $ 24,537 Change in fair value: Included in results of operations 1,031 Balance at June 30, 2019 $ 25,568
Reconciliation of the Beginning and Ending Balances of Level 3 Liabilities	The following table reconciles the beginning and ending balances of our Level 3 assets and liabilities as of June 30, 2019 : June 30, 2019 (In thousands) Contingent consideration Balance at December 31, 2018 $ 24,537 Change in fair value: Included in results of operations 1,031 Balance at June 30, 2019 $ 25,568

Derivative Contracts (Tables)

Derivative Contracts (Tables)	6 Months Ended
	Jun. 30, 2019
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Fair Values and Presentation of Derivative Financial Instruments	The following table summarizes the fair values and the presentation of our derivative assets (liabilities) in the Condensed Consolidated Balance Sheets: (In thousands) Balance Sheet Component June 30, December 31, Derivative financial instruments: Common Stock options/warrants Investments, net $ 488 $ 855 Forward contracts Unrealized gains on forward contracts are recorded in Other current assets and prepaid expenses. Unrealized (losses) on forward contracts are recorded in Accrued expenses. $ 64 $ 21
Summary of Derivative Instrument Losses and Gains Recorded	The following table summarizes the losses and gains recorded for the three and six months ended June 30, 2019 and 2018: Three months ended June 30, Six months ended June 30, (In thousands) 2019 2018 2019 2018 Derivative gain (loss): Common Stock options/warrants $ (392 ) $ 1,916 $ (24 ) $ 3,587 Forward contracts 4 332 51 57 Total $ (388 ) $ 2,248 $ 27 $ 3,644

Revenue Recognition (Tables)

Revenue Recognition (Tables)	6 Months Ended
	Jun. 30, 2019
Revenue from Contract with Customer [Abstract]
Schedule of Disaggregation of Revenue	The composition of Revenue from services by payor for the three and six months ended June 30, 2019 and 2018 is as follows: Three months ended June 30, Six months ended June 30, (In thousands) 2019 2018 2019 2018 Healthcare insurers $ 106,278 $ 131,695 $ 211,207 $ 262,769 Government payers 28,634 38,860 59,037 75,103 Client payers 38,101 39,664 76,559 77,830 Patients 5,445 5,836 10,546 11,667 Total $ 178,458 $ 216,055 $ 357,349 $ 427,369
Schedule of Product Sales Allowances and Accruals	The following table presents an analysis of product sales allowances and accruals as contract liabilities for the six months ended June 30, 2019 : (In thousands) Chargebacks, discounts, rebates and fees Governmental Returns Total Balance at December 31, 2018 $ 1,316 $ 2,090 $ 637 $ 4,043 Provision related to current period sales 4,716 9,791 1,380 15,887 Adjustment related to prior period sales (9 ) 211 — 202 Credits or payments made (4,611 ) (8,264 ) (1,169 ) (14,044 ) Balance at June 30, 2019 $ 1,412 $ 3,828 $ 848 $ 6,088 Total gross Rayaldee sales $ 27,580 Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales 58 %

Segments (Tables)

Segments (Tables)	6 Months Ended
	Jun. 30, 2019
Segment Reporting [Abstract]
Operations and Assets for Operating Segments and Geographic Information	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 June 30, For the six months ended June 30, (In thousands) 2019 2018 2019 2018 Revenue from services: Pharmaceutical $ — $ — $ — $ — Diagnostics 178,458 216,055 357,349 427,369 Corporate — — — — $ 178,458 $ 216,055 $ 357,349 $ 427,369 Revenue from products: Pharmaceutical $ 28,680 $ 28,523 $ 53,981 $ 56,374 Diagnostics — — — — Corporate — — — — $ 28,680 $ 28,523 $ 53,981 $ 56,374 Revenue from transfer of intellectual property and other: Pharmaceutical $ 19,230 $ 19,107 $ 37,490 $ 34,855 Diagnostics — — — — Corporate — — — — $ 19,230 $ 19,107 $ 37,490 $ 34,855 Operating loss: Pharmaceutical $ (8,556 ) $ 2,165 $ (38,033 ) $ (20,783 ) Diagnostics (28,013 ) 1,475 (61,582 ) (6,543 ) Corporate (10,691 ) (8,748 ) (22,962 ) (20,393 ) $ (47,260 ) $ (5,108 ) $ (122,577 ) $ (47,719 ) Depreciation and amortization: Pharmaceutical $ 7,382 $ 6,752 $ 14,908 $ 13,492 Diagnostics 16,260 17,989 32,530 35,975 Corporate 19 21 39 51 $ 23,661 $ 24,762 $ 47,477 $ 49,518 Loss from investment in investees: Pharmaceutical $ (271 ) $ (6,942 ) $ (2,125 ) $ (9,114 ) Diagnostics — (271 ) — (555 ) Corporate — — — — $ (271 ) $ (7,213 ) $ (2,125 ) $ (9,669 ) Revenues: United States $ 184,310 $ 222,535 $ 369,203 $ 437,845 Ireland 22,174 20,778 42,707 38,060 Chile 9,051 11,937 16,915 23,670 Spain 4,876 4,592 9,294 10,125 Israel 3,768 2,526 6,884 6,141 Mexico 2,058 1,302 3,589 2,723 Other 131 15 228 34 $ 226,368 $ 263,685 $ 448,820 $ 518,598 (In thousands) June 30, December 31, Assets: Pharmaceutical $ 1,239,338 $ 1,236,499 Diagnostics 1,138,673 1,162,160 Corporate 78,217 52,413 $ 2,456,228 $ 2,451,072 Goodwill: Pharmaceutical $ 247,055 $ 247,407 Diagnostics 452,787 452,786 Corporate — — $ 699,842 $ 700,193

Leases (Tables)

Leases (Tables)	6 Months Ended
	Jun. 30, 2019
Leases [Abstract]
Lease Assets and Liabilities	The following table presents the lease balances within the Condensed Consolidated Balance Sheet as of June 30, 2019: (in thousands) Classification on the Balance Sheet June 30, 2019 Assets Operating lease assets Operating lease right-of-use assets $ 29,640 Finance lease assets Property, plant and equipment, net 7,681 Liabilities Current Operating lease liabilities Current maturities of operating leases 13,376 Accrued expenses Current maturities of finance leases 3,031 Long-term Operating lease liabilities Operating lease liabilities 16,673 Other long-term liabilities Finance lease liabilities $ 4,650 Weighted average remaining lease term Operating leases 2.1 years Finance leases 2.5 years Weighted average discount rate Operating leases 4.3 % Finance leases 4.5 %
Lease Liability Maturity	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 year to the total operating lease liabilities recognized on our Condensed Consolidated Balance Sheet as of June 30, 2019: (in thousands) Operating Finance July 1, 2019 through December 31, 2019 $ 7,968 $ 1,661 2020 10,169 2,649 2021 6,678 1,938 2022 3,754 960 2023 2,329 368 Thereafter 2,096 419 Total undiscounted future minimum lease payments 32,994 7,995 Less: Difference between lease payments and discounted lease liabilities 2,945 314 Total lease liabilities $ 30,049 $ 7,681
Lease Liability Maturity	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 year to the total operating lease liabilities recognized on our Condensed Consolidated Balance Sheet as of June 30, 2019: (in thousands) Operating Finance July 1, 2019 through December 31, 2019 $ 7,968 $ 1,661 2020 10,169 2,649 2021 6,678 1,938 2022 3,754 960 2023 2,329 368 Thereafter 2,096 419 Total undiscounted future minimum lease payments 32,994 7,995 Less: Difference between lease payments and discounted lease liabilities 2,945 314 Total lease liabilities $ 30,049 $ 7,681
Lease Cash Flows	Supplemental cash flow information is as follows: (in thousands) Six months ended June 30, 2019 Operating cash flows from operating leases $ 10,804 Operating cash flows from finance leases 234 Financing cash flows from finance leases 1,590 Total $ 12,628

Business and Organization (Deta

Business and Organization (Details)	6 Months Ended
	Jun. 30, 2019employee
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Number of sales employees	300

Summary of Significant Accoun_3

Summary of Significant Accounting Policies (Details) $ in Thousands	Jun. 30, 2019USD ($)	Dec. 31, 2018USD ($)	Jun. 30, 2019USD ($)	Jun. 30, 2018USD ($)	Jun. 30, 2019USD ($)Segment	Jun. 30, 2018USD ($)	Jan. 01, 2019USD ($)
Summary of Significant Accounting Policies [Line Items]
Provision for inventory obsolescence					$ 1,300	$ 1,200
Goodwill, in-process research and development and other intangible assets acquired	$ 1,900,000	$ 2,000,000	$ 1,900,000		1,900,000
Amortization expense			16,419	$ 17,227	32,981	34,498
Depreciation expense					14,500	15,000
Allowance for doubtful accounts receivable	(2,127)	$ (1,758)	(2,127)		(2,127)
Provision related to current period sales					200	200
Equity-based compensation expense					$ 7,600	$ 11,500
Number of reportable segments | Segment					2
Lease liabilities	30,049		30,049		$ 30,049
Operating lease right-of-use assets	$ 29,640		$ 29,640		$ 29,640
Minimum
Summary of Significant Accounting Policies [Line Items]
Intangible assets, estimated useful lives					3 years
Maximum
Summary of Significant Accounting Policies [Line Items]
Intangible assets, estimated useful lives					20 years
Government Contracts Concentration Risk | Accounts Receivable
Summary of Significant Accounting Policies [Line Items]
Concentration percentage	9.60%	7.40%
Customer Concentration Risk | Accounts Receivable
Summary of Significant Accounting Policies [Line Items]
Concentration percentage	2.00%	2.90%
Software
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, estimated useful lives					3 years
Machinery, Medical and Other Equipment | Minimum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, estimated useful lives					5 years
Machinery, Medical and Other Equipment | Maximum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, estimated useful lives					8 years
Furniture and Fixtures | Minimum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, estimated useful lives					5 years
Furniture and Fixtures | Maximum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, estimated useful lives					12 years
Buildings and Improvements | Minimum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, estimated useful lives					10 years
Buildings and Improvements | Maximum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, estimated useful lives					40 years
Automobiles and Aircraft | Minimum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, estimated useful lives					3 years
Automobiles and Aircraft | Maximum
Summary of Significant Accounting Policies [Line Items]
Property, plant and equipment, estimated useful lives					5 years
Accounting Standards Update 2016-02
Summary of Significant Accounting Policies [Line Items]
Lease liabilities							$ 33,700
Operating lease right-of-use assets							$ 33,300

Earnings (Loss) Per Share - Nar

Earnings (Loss) Per Share - Narrative (Details) - $ / shares	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018	Dec. 31, 2018
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Common stock, par value (in dollars per share)	$ 0.01		$ 0.01		$ 0.01
Number of common stock warrant and common stock options exercised (in shares)	0	332,000	24,877	332,000
Number of common stock issued for stock warrant and stock options exercised (in shares)	0	145,677	19,232	145,677
Shares surrendered in lieu of cash payment (in shares)		186,323	5,645	186,323
Common Stock
Antidilutive Securities Excluded from Computation of Earnings Per Share [Line Items]
Dilutive potential shares (in shares)			68,933,402	61,760,134

Composition of Certain Financ_3

Composition of Certain Financial Statement Captions (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Accounts receivable, net:
Accounts receivable	$ 150,414	$ 145,665
Less: allowance for doubtful accounts	(2,127)	(1,758)
Accounts receivable, net	148,287	143,907
Inventories, net:
Consumable supplies	22,008	23,264
Finished products	21,481	15,259
Work in-process	3,096	2,473
Raw materials	4,741	4,259
Less: inventory reserve	(3,033)	(2,956)
Inventory, net	48,293	42,299
Other current assets and prepaid expenses:
Taxes recoverable	18,176	15,708
Other receivables	661	2,368
Prepaid supplies	10,584	9,693
Prepaid insurance	3,878	3,436
Other	3,234	3,847
Other current assets and prepaid expenses	36,533	35,052
Intangible assets, net:
Less: accumulated amortization	(291,649)	(258,539)
Intangible assets, net	581,306	614,452
Accrued expenses:
Contract liabilities	50,388	63,503
Employee benefits	39,453	45,621
Clinical trials	9,936	10,401
Contingent consideration	5,387	2,375
Finance leases short-term	3,031
Finance leases short-term		3,280
Milestone payment	4,968	4,871
Professional fees	3,317	7,935
Other	81,902	65,527
Accrued expenses	198,382	203,513
Other long-term liabilities:
Contract liabilities	3,665	27,566
Line of credit	65,112	105,198
Contingent consideration	20,181	22,162
Mortgages and other debts payable	4,500	4,654
Finance leases long-term	4,650
Finance leases long-term		5,620
Other	29,643	33,768
Other long-term liabilities	127,751	198,968
Customer relationships
Intangible assets, net:
Intangible assets	446,144	446,296
Technologies
Intangible assets, net:
Intangible assets	340,702	340,729
Trade names
Intangible assets, net:
Intangible assets	50,420	50,404
Licenses
Intangible assets, net:
Intangible assets	5,766	5,766
Covenants not to compete
Intangible assets, net:
Intangible assets	16,321	16,322
Product registrations
Intangible assets, net:
Intangible assets	8,016	7,861
Other
Intangible assets, net:
Intangible assets	$ 5,586	$ 5,613

Composition of Certain Financ_4

Composition of Certain Financial Statement Captions - Narrative (Details)	6 Months Ended
	Jun. 30, 2019
Covenants not to compete
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	5 years
Minimum | Technology
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	5 years
Minimum | Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	7 years
Minimum | Product registrations
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	7 years
Minimum | Trade names
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	5 years
Minimum | Other
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	9 years
Maximum | Technology
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	17 years
Maximum | Customer relationships
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	20 years
Maximum | Product registrations
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	10 years
Maximum | Trade names
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	10 years
Maximum | Other
Acquired Finite-Lived Intangible Assets [Line Items]
Useful life	10 years

Composition of Certain Financ_5

Composition of Certain Financial Statement Captions - Changes in Goodwill (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2019USD ($)
Goodwill [Roll Forward]
Beginning balance	$ 700,193
Foreign exchange and other	(351)
Ending balance	699,842
BioReference
Goodwill [Roll Forward]
Ending balance	401,800
Pharmaceutical | CURNA
Goodwill [Roll Forward]
Beginning balance	4,827
Foreign exchange and other	0
Ending balance	4,827
Pharmaceutical | EirGen
Goodwill [Roll Forward]
Beginning balance	85,245
Foreign exchange and other	(551)
Ending balance	84,694
Pharmaceutical | FineTech
Goodwill [Roll Forward]
Beginning balance	0
Foreign exchange and other	0
Ending balance	0
Pharmaceutical | OPKO Chile
Goodwill [Roll Forward]
Beginning balance	4,614
Foreign exchange and other	112
Ending balance	4,726
Pharmaceutical | OPKO Biologics
Goodwill [Roll Forward]
Beginning balance	139,784
Foreign exchange and other	0
Ending balance	139,784
Pharmaceutical | OPKO Health Europe
Goodwill [Roll Forward]
Beginning balance	7,545
Foreign exchange and other	(49)
Ending balance	7,496
Pharmaceutical | OPKO Renal
Goodwill [Roll Forward]
Beginning balance	2,069
Foreign exchange and other	0
Ending balance	2,069
Pharmaceutical | Transition Therapeutics
Goodwill [Roll Forward]
Beginning balance	3,323
Foreign exchange and other	137
Ending balance	3,460
Diagnostics | BioReference
Goodwill [Roll Forward]
Beginning balance	401,821
Foreign exchange and other	0
Ending balance	401,821
Diagnostics | OPKO Diagnostics
Goodwill [Roll Forward]
Beginning balance	17,977
Foreign exchange and other	0
Ending balance	17,977
Diagnostics | OPKO Lab
Goodwill [Roll Forward]
Beginning balance	32,988
Foreign exchange and other	0
Ending balance	$ 32,988

Investments - Summary of Invest

Investments - Summary of Investments (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Business Combinations [Abstract]
Equity method investments	$ 1,975
Variable interest entity, equity method	1,010
Equity securities	20,856	$ 26,313
Equity securities with no readily determinable fair value	438
Warrants and options	488
Total carrying value of investments	24,767	$ 31,228
Equity method investment, underlying equity in net assets	$ 10,616

Investments - Narrative (Detail

Investments - Narrative (Details) $ in Millions	6 Months Ended
	Jun. 30, 2019USD ($)shares
Investment [Line Items]
Total assets of equity method investees | $	$ 183.7
Total (liabilities) of equity method investees | $	(51.9)
Net losses of equity method investees | $	(23.3)
Market value | $	$ 12.5
Pharmsynthez
Investment [Line Items]
Ownership percentage, equity method	9.00%
Cocrystal
Investment [Line Items]
Ownership percentage, equity method	8.00%
Number of shares into which warrants may be converted (in shares)	33,000
Non-Invasive Monitoring Systems, Inc.
Investment [Line Items]
Ownership percentage, equity method	1.00%
Neovasc
Investment [Line Items]
Ownership percentage, equity method	5.00%
InCellDx, Inc
Investment [Line Items]
Ownership percentage, equity method	29.00%
Number of shares into which warrants may be converted (in shares)	700,000
BioCardia, Inc.
Investment [Line Items]
Ownership percentage, equity method	5.00%
Ownership percentage	5.00%
Number of shares into which warrants may be converted (in shares)	47,000
Investment options, vested (in shares)	23,000
Xenetic Biosciences, Inc.
Investment [Line Items]
Ownership percentage, equity method	4.00%
Number of shares into which warrants may be converted (in shares)	40,000
Phio Pharmaceuticals
Investment [Line Items]
Ownership percentage	0.20%
Number of shares into which warrants may be converted (in shares)	22,000
VBI Vaccines Inc
Investment [Line Items]
Ownership percentage	7.00%
ChromaDex
Investment [Line Items]
Ownership percentage	0.10%
MabVax
Investment [Line Items]
Ownership percentage	1.00%
Eloxx Pharmaceuticals
Investment [Line Items]
Ownership percentage	4.00%
Zebra
Investment [Line Items]
Ownership percentage, equity method	29.00%
Series A-2 Preferred Stock | Zebra
Investment [Line Items]
Investment owned (in shares)	1,260,000
Restricted Stock | Zebra
Investment [Line Items]
Shares received as a gift (in shares)	900,000

Investments - Schedule of Net G

Investments - Schedule of Net Gains and Losses on Equity Securities (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2019USD ($)
Business Combinations [Abstract]
Net gains and losses recognized during the period on equity securities	$ (5,458)
Less: Net gains and losses realized during the period on equity securities	0
Unrealized net gains recognized during the period on equity securities still held at the reporting date	$ (5,458)

Debt - Narrative (Details)

Debt - Narrative (Details)

Feb. 20, 2019USD ($)

Jan. 30, 2013USD ($)

Feb. 28, 2019USD ($)day$ / sharesshares

Feb. 28, 2018USD ($)$ / shares

Nov. 30, 2015USD ($)

Jan. 31, 2013

Sep. 30, 2019

Jun. 30, 2019USD ($)institutionshares

Jun. 30, 2018USD ($)

Dec. 31, 2016USD ($)shares

Feb. 01, 2019USD ($)

Dec. 31, 2018USD ($)institution

Nov. 08, 2018USD ($)

Debt Instrument [Line Items]

Repayments of lines of credit

$ 78,824,000

$ 20,924,000

Credit line capacity

122,479,000

Long-term line of credit, noncurrent

65,112,000

$ 105,198,000

Goodwill

$ 699,842,000

$ 700,193,000

Number of financial institutions | institution

11

11

BioReference

Debt Instrument [Line Items]

Net assets

$ 882,600,000

Goodwill

401,800,000

Intangible assets

$ 385,500,000

OPKO Health Europe

Debt Instrument [Line Items]

Weighted average interest rate

2.70%

2.10%

Minimum | OPKO Health Europe

Debt Instrument [Line Items]

Variable interest rates

1.30%

Maximum | OPKO Health Europe

Debt Instrument [Line Items]

Variable interest rates

3.80%

Convertible Debt

Debt Instrument [Line Items]

Interest rate on notes payable

4.50%

Convertible Debt | Convertible Senior Notes Due 2025

Debt Instrument [Line Items]

Debt face amount

$ 200,000,000

Conversion rate

0.2367

Conversion price per share (in dollars per share) | $ / shares

$ 4.22

Shares issuable under debt agreement (in shares) | shares

30,000,000

Shares issued on converted debt (in shares) | shares

29,250,000

Proceeds one-time nominal fee

$ 300,000

Equity component of convertible debt

$ 52,600,000

Effective interest rate

11.20%

Convertible Debt | Convertible Senior Notes Due 2025 | Redemption period one

Debt Instrument [Line Items]

Convertible debt, threshold percentage of stock price trigger

130.00%

Equivalent redemption price

100.00%

Convertible Debt | Convertible Senior Notes Due 2025 | Redemption period one | Minimum

Debt Instrument [Line Items]

Number of trading days | day

20

Convertible Debt | Convertible Senior Notes Due 2025 | Redemption period one | Maximum

Debt Instrument [Line Items]

Number of consecutive trading days applicable conversion price | day

30

Convertible Debt | Convertible Senior Notes Due 2025 | Redemption period two

Debt Instrument [Line Items]

Convertible debt, threshold percentage of stock price trigger

98.00%

Convertible Debt | Convertible Senior Notes Due 2025 | Redemption period two | Minimum

Debt Instrument [Line Items]

Number of trading days | day

5

Convertible Debt | Convertible Senior Notes Due 2025 | Redemption period two | Maximum

Debt Instrument [Line Items]

Number of consecutive trading days applicable conversion price | day

5

Convertible Debt | Convertible Senior Notes Due 2025 | Redemption period three

Debt Instrument [Line Items]

Convertible debt, threshold percentage of stock price trigger

130.00%

Equivalent redemption price

100.00%

Convertible Debt | Convertible Senior Notes Due 2025 | Redemption period three | Minimum

Debt Instrument [Line Items]

Number of trading days | day

20

Convertible Debt | Convertible Senior Notes Due 2025 | Redemption period three | Maximum

Debt Instrument [Line Items]

Number of consecutive trading days applicable conversion price | day

30

Convertible Debt | 5% Convertible Notes

Debt Instrument [Line Items]

Debt face amount

$ 55,000,000

Interest rate on notes payable

5.00%

Conversion price per share (in dollars per share) | $ / shares

$ 5

Maturity duration

5 years

Minimum conversion notice

30 days

Maximum conversion notice

60 days

Convertible Debt | Notes Due February 1, 2033

Debt Instrument [Line Items]

Converted debt amount

$ 143,200,000

Senior Notes

Debt Instrument [Line Items]

Remaining principal

$ 144,432,000

$ 0

Senior Notes | Notes Due February 1, 2033

Debt Instrument [Line Items]

Debt face amount

$ 175,000,000

Interest rate on notes payable

3.00%

Equivalent redemption price

100.00%

Notes | Notes Due February 1, 2033

Debt Instrument [Line Items]

Equivalent redemption price

100.00%

Debt repurchase amount

$ 28,800,000

Remaining principal

$ 3,000,000

Line of Credit

Debt Instrument [Line Items]

Weighted average interest rate

4.50%

4.70%

Line of Credit | Unsecured Debt

Debt Instrument [Line Items]

Interest rate on notes payable

10.00%

Credit line capacity

$ 60,000,000

Revolving Credit Facility | Line of Credit | New Credit Agreement

Debt Instrument [Line Items]

Credit line capacity

$ 100,000,000

Long-term line of credit, noncurrent

$ 65,100,000

Higher borrowing capacity option

$ 275,000,000

Remaining borrowing capacity

$ 1,700,000

Commitment fee percentage

0.50%

Swingline | Line of Credit | New Credit Agreement

Debt Instrument [Line Items]

Credit line capacity

$ 20,000,000

Letter of Credit | Line of Credit | New Credit Agreement

Debt Instrument [Line Items]

Credit line capacity

$ 20,000,000

LIBOR | Revolving Credit Facility | Line of Credit | New Credit Agreement

Debt Instrument [Line Items]

Basis spread on variable rate

2.50%

LIBOR, First 12 Months | Revolving Credit Facility | Line of Credit | New Credit Agreement

Debt Instrument [Line Items]

Basis spread on variable rate

0.35%

LIBOR Thereafter | Revolving Credit Facility | Line of Credit | New Credit Agreement

Debt Instrument [Line Items]

Basis spread on variable rate

0.50%

LIBOR, First 12 Months, Adjusted for Eurocurrency Liabilities | Revolving Credit Facility | Line of Credit | New Credit Agreement

Debt Instrument [Line Items]

Basis spread on variable rate

1.35%

LIBOR, Thereafter, Adjusted for Eurocurrency Liabilities | Revolving Credit Facility | Line of Credit | New Credit Agreement

Debt Instrument [Line Items]

Basis spread on variable rate

1.50%

Common Stock | Convertible Debt | Notes Due February 1, 2033

Debt Instrument [Line Items]

Shares issued on converted debt (in shares) | shares

21,539,873

Dr Frost | Line of Credit | Unsecured Debt

Debt Instrument [Line Items]

Repayments of lines of credit

$ 28,800,000

Credit line capacity

$ 60,000,000

Subsequent Event | Minimum

Debt Instrument [Line Items]

Consecutive days

30 days

Subsequent Event | Maximum

Debt Instrument [Line Items]

Percentage of total revolving commitment

10.00%

Debt - Schedule of Notes (Detai

Debt - Schedule of Notes (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018
2025 Senior Notes
Issuance of 4.50% convertible notes	$ 200,293	$ 55,000
Debt Issuance Cost
Amortization of debt discount and debt issuance costs	308	$ 99
Senior Notes
2025 Senior Notes
Beginning balance	0
Issuance of 4.50% convertible notes	200,000
Ending balance	200,000
Discount
Beginning balance	0
Issuance of 4.50% convertible notes	(52,600)
Amortization of debt discount and debt issuance costs	2,483
Ending balance	(50,117)
Debt Issuance Cost
Beginning balance	0
Issuance of 4.50% convertible notes	(5,720)
Amortization of debt discount and debt issuance costs	269
Ending balance	(5,451)
Total
Beginning balance	0
Issuance of 4.50% convertible notes	141,680
Amortization of debt discount and debt issuance costs	2,752
Ending balance	$ 144,432

Debt - Lines of Credit (Details

Debt - Lines of Credit (Details) - USD ($)	Jun. 30, 2019	Dec. 31, 2018
Line of Credit Facility [Line Items]
Credit line capacity	$ 122,479,000
Balance Outstanding	$ 74,041,000	$ 108,710,000
JPMorgan Chase
Line of Credit Facility [Line Items]
Interest rate on borrowings at June 30, 2019	4.26%
Credit line capacity	$ 100,000,000
Balance Outstanding	$ 68,559,000	105,198,000
Itau Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings at June 30, 2019	5.50%
Credit line capacity	$ 1,810,000
Balance Outstanding	$ 1,287,000	232,000
Bank of Chile
Line of Credit Facility [Line Items]
Interest rate on borrowings at June 30, 2019	6.60%
Credit line capacity	$ 3,800,000
Balance Outstanding	$ 1,347,000	432,000
BICE Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings at June 30, 2019	5.50%
Credit line capacity	$ 2,500,000
Balance Outstanding	$ 221,000	818,000
BBVA Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings at June 30, 2019	5.50%
Credit line capacity	$ 3,250,000
Balance Outstanding	$ 472,000	858,000
Security Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings at June 30, 2019	5.50%
Credit line capacity	$ 296,000
Balance Outstanding	$ 296,000	0
Estado Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings at June 30, 2019	5.50%
Credit line capacity	$ 3,500,000
Balance Outstanding	$ 1,164,000	308,000
Santander Bank
Line of Credit Facility [Line Items]
Interest rate on borrowings at June 30, 2019	5.50%
Credit line capacity	$ 4,500,000
Balance Outstanding	$ 561,000	852,000
Scotiabank
Line of Credit Facility [Line Items]
Interest rate on borrowings at June 30, 2019	5.00%
Credit line capacity	$ 1,800,000
Balance Outstanding	$ 8,000	2,000
Banco De Sabadell
Line of Credit Facility [Line Items]
Interest rate on borrowings at June 30, 2019	1.45%
Credit line capacity	$ 341,000
Balance Outstanding	$ 126,000	0
Banco Bilbao Vizcaya
Line of Credit Facility [Line Items]
Interest rate on borrowings at June 30, 2019	2.75%
Credit line capacity	$ 341,000
Balance Outstanding	$ 0	0
Banco Santander
Line of Credit Facility [Line Items]
Interest rate on borrowings at June 30, 2019	1.40%
Credit line capacity	$ 341,000
Balance Outstanding	$ 0	$ 10,000

Debt - Notes Payable and Other

Debt - Notes Payable and Other Debt (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Mortgage notes and other debt payables
Other long-term liabilities	$ 127,751	$ 198,968
Notes Payable and Other Long-Term Liabilities
Mortgage notes and other debt payables
Current portion of notes payable	2,649	2,560
Other long-term liabilities	5,425	5,693
Total	$ 8,074	$ 8,253

Accumulated Other Comprehensi_3

Accumulated Other Comprehensive Income (Loss) (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2019USD ($)
Accumulated Other Comprehensive Income (Loss), Net [Rollforward]
Beginning balance	$ 1,791,291
Ending balance	1,708,931
Foreign currency translation
Accumulated Other Comprehensive Income (Loss), Net [Rollforward]
Beginning balance	(20,131)
Other comprehensive loss before reclassifications	(220)
Net other comprehensive loss	(220)
Ending balance	$ (20,351)

Fair Value Measurements - Asset

Fair Value Measurements - Assets And Liabilities Measured At Fair Value (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Assets:
Equity securities	$ 20,856	$ 26,313
Common stock options/warrants	488	855
Total assets	21,408	27,189
Liabilities:
Contingent consideration	25,568	24,537
Total liabilities	25,568	24,537
Quoted prices in active markets for identical assets (Level 1)
Assets:
Equity securities	20,856	26,313
Common stock options/warrants	0	0
Total assets	20,856	26,313
Liabilities:
Contingent consideration	0	0
Total liabilities	0	0
Significant other observable inputs (Level 2)
Assets:
Equity securities	0	0
Common stock options/warrants	488	855
Total assets	552	876
Liabilities:
Contingent consideration	0	0
Total liabilities	0	0
Significant unobservable inputs (Level 3)
Assets:
Equity securities	0	0
Common stock options/warrants	0	0
Total assets	0	0
Liabilities:
Contingent consideration	25,568	24,537
Total liabilities	25,568	24,537
Forward Contracts
Assets:
Forward contracts	64
Forward Contracts | Quoted prices in active markets for identical assets (Level 1)
Assets:
Forward contracts	0
Forward Contracts | Significant other observable inputs (Level 2)
Assets:
Forward contracts	64
Forward Contracts | Significant unobservable inputs (Level 3)
Assets:
Forward contracts	$ 0
Forward Contracts
Assets:
Forward contracts		21
Forward Contracts | Quoted prices in active markets for identical assets (Level 1)
Assets:
Forward contracts		0
Forward Contracts | Significant other observable inputs (Level 2)
Assets:
Forward contracts		21
Forward Contracts | Significant unobservable inputs (Level 3)
Assets:
Forward contracts		$ 0

Fair Value Measurements - Level

Fair Value Measurements - Level 3 Reconciliation (Details) - Contingent consideration $ in Thousands	6 Months Ended
	Jun. 30, 2019USD ($)
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning Balance	$ 24,537
Included in results of operations	1,031
Ending Balance	$ 25,568

Fair Value Measurements - Narra

Fair Value Measurements - Narrative (Details) - USD ($) $ in Thousands	6 Months Ended
	Jun. 30, 2019	Dec. 31, 2018
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Decrease of estimated future sales in amount	$ 1,400
Contingent consideration	25,568	$ 24,537
Accrued Expenses
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration	5,400	2,400
Other Noncurrent Liabilities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration	$ 20,200	$ 22,200

Derivative Contracts - Balance

Derivative Contracts - Balance Sheet Component (Details) - USD ($) $ in Thousands	Jun. 30, 2019	Dec. 31, 2018
Derivatives, Fair Value [Line Items]
Derivative asset	$ 488	$ 855
Not Designated as Hedging Instrument | Common Stock options/warrants | Investments, net
Derivatives, Fair Value [Line Items]
Derivative asset	488	855
Not Designated as Hedging Instrument | Forward contracts | Unrealized gains on forward contracts are recorded in Other current assets and prepaid expenses. Unrealized (losses) on forward contracts are recorded in Accrued expenses.
Derivatives, Fair Value [Line Items]
Derivative asset	$ 64	$ 21

Derivative Contracts - Derivati

Derivative Contracts - Derivative Gains (Losses) (Details) - Not Designated as Hedging Instrument - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Derivative Instruments, Gain (Loss) [Line Items]
Derivative gain (loss)	$ (388)	$ 2,248	$ 27	$ 3,644
Common Stock options/warrants
Derivative Instruments, Gain (Loss) [Line Items]
Derivative gain (loss)	(392)	1,916	(24)	3,587
Forward contracts
Derivative Instruments, Gain (Loss) [Line Items]
Derivative gain (loss)	$ 4	$ 332	$ 51	$ 57

Related Party Transactions (Det

Related Party Transactions (Details)

Feb. 20, 2019USD ($)

Nov. 08, 2018USD ($)$ / sharesshares

Mar. 31, 2019USD ($)

Feb. 28, 2019USD ($)

May 31, 2018shares

Apr. 30, 2018shares

Feb. 28, 2018USD ($)

Nov. 30, 2017USD ($)shares

Apr. 30, 2017USD ($)shares

Nov. 30, 2016USD ($)

Jun. 30, 2019USD ($)shares

Mar. 31, 2019USD ($)shares

Jun. 30, 2018USD ($)

Jun. 30, 2019USD ($)shares

Jun. 30, 2018USD ($)

Dec. 31, 2018

Mar. 01, 2019shares

Jan. 01, 2017USD ($)ft²

Related Party Transaction [Line Items]

Private placement agreement number of shares (in shares) | shares

26,500,000

Private placement agreement price per share (in dollars per share) | $ / shares

$ 3.49

Private placement agreement value of shares

$ 92,500,000

Credit line capacity

$ 122,479,000

$ 122,479,000

Repayments of lines of credit

$ 78,824,000

$ 20,924,000

Reverse stock split

0.01

Reimbursement paid to related party for travel

$ 61,000

$ 140,000

Pharmsynthez

Related Party Transaction [Line Items]

Equity method investment, ownership percentage

9.00%

9.00%

Zebra

Related Party Transaction [Line Items]

Equity method investment, ownership percentage

29.00%

29.00%

Stock ownership percentage

29.00%

Neovasc

Related Party Transaction [Line Items]

Equity method investment, ownership percentage

5.00%

5.00%

Additional investment in equity method investment

$ 3,000,000

ChromaDex Corporation

Related Party Transaction [Line Items]

Ownership percentage

0.10%

0.10%

MabVax

Related Party Transaction [Line Items]

Ownership percentage

1.00%

1.00%

COCP

Related Party Transaction [Line Items]

Equity method investment, ownership percentage

8.00%

8.00%

Additional investment in equity method investment

$ 1,000,000

Number of shares into which warrants may be converted (in shares) | shares

33,000

33,000

NIMS

Related Party Transaction [Line Items]

Ownership percentage

1.00%

1.00%

Eloxx Pharmaceuticals

Related Party Transaction [Line Items]

Ownership percentage

4.00%

4.00%

BioCardia, Inc.

Related Party Transaction [Line Items]

Equity method investment, ownership percentage

5.00%

5.00%

Ownership percentage

5.00%

5.00%

Number of shares into which warrants may be converted (in shares) | shares

47,000

47,000

InCellDx, Inc

Related Party Transaction [Line Items]

Equity method investment, ownership percentage

29.00%

29.00%

Number of shares into which warrants may be converted (in shares) | shares

700,000

700,000

Dr. Jan Hsiao

Related Party Transaction [Line Items]

Private placement agreement value of shares

2,000,000

Dr. Frost

Related Party Transaction [Line Items]

Private placement agreement value of shares

70,000,000

Frost Real Estate Holdings LLC

Related Party Transaction [Line Items]

Area of real estate property (in square feet) | ft²

29,500

Lease payments per month in first year

$ 81,000

Lease payments per month in third year

$ 86,000

Federal Trade Commission Filing Fees | Dr. Jan Hsiao

Related Party Transaction [Line Items]

Related party transaction amount

$ 125,000

Federal Trade Commission Filing Fees | Dr. Frost

Related Party Transaction [Line Items]

Related party transaction amount

$ 280,000

Shares Received Upon Closing of Xenetic Transaction [Member] | Director

Related Party Transaction [Line Items]

Shares received upon closing of transaction (in shares) | shares

31,240

31,240

Reimbursement of Travel Expense | Dr. Frost

Related Party Transaction [Line Items]

Reimbursement paid to related party for travel

$ 122,000

$ 160,000

Common Stock | Neovasc

Related Party Transaction [Line Items]

Equity method investment, additional investment in period (in shares) | shares

20,547

Common Stock | COCP

Related Party Transaction [Line Items]

Equity method investment, additional investment in period (in shares) | shares

138,889

Xenetic | OPKO Transaction Shares | Affiliate

Related Party Transaction [Line Items]

Issuance of shares (in shares) | shares

164,062

Xenetic | Institute Transaction Shares | Affiliate

Related Party Transaction [Line Items]

Issuance of shares (in shares) | shares

54,687

Museum of Science, Inc | Dr Frost and Mr Pfenniger

Related Party Transaction [Line Items]

Related party future contribution

$ 1,000,000

Related party future contribution term

4 years

Convertible Debt

Related Party Transaction [Line Items]

Interest rate on credit facility

4.50%

Convertible Debt | COCP

Related Party Transaction [Line Items]

Additional investment in equity method investment

$ 1,000,000

Convertible Debt | Common Stock | COCP

Related Party Transaction [Line Items]

Shares received after conversion (in shares) | shares

538,544

5% Convertible Notes | Convertible Debt

Related Party Transaction [Line Items]

Interest rate on credit facility

5.00%

Debt face amount

$ 55,000,000

Series A Warrant | Neovasc

Related Party Transaction [Line Items]

Number of shares into which warrants may be converted (in shares) | shares

20,547

Proceeds from warrant exercises

$ 1,200,000

Series B Warrant | Neovasc

Related Party Transaction [Line Items]

Number of shares into which warrants may be converted (in shares) | shares

20,547

Shares received upon exercise of warrant (in shares) | shares

1,069,090

Series C Warrant | Neovasc

Related Party Transaction [Line Items]

Number of shares into which warrants may be converted (in shares) | shares

8,221

Shares received upon exercise of warrant (in shares) | shares

2,266,023

Line of Credit | Unsecured Debt

Related Party Transaction [Line Items]

Credit line capacity

$ 60,000,000

Interest rate on credit facility

10.00%

Line of Credit | Unsecured Debt | Dr. Frost

Related Party Transaction [Line Items]

Repayments of lines of credit

$ 28,800,000

Commitments and Contingencies (

Commitments and Contingencies (Details)	Dec. 27, 2018USD ($)	Sep. 07, 2018lawsuit	Jun. 30, 2019USD ($)lawsuit	Dec. 31, 2018USD ($)
Business Acquisition, Contingent Consideration
Contingent consideration			$ 25,568,000	$ 24,537,000
Number of class action lawsuits | lawsuit			2
Payments for legal settlements	$ 100,000
Number of derivative lawsuits (at least) | lawsuit		12
Purchase obligation			$ 69,800,000
Accrued Liabilities
Business Acquisition, Contingent Consideration
Contingent consideration			5,400,000	2,400,000
Other Noncurrent Liabilities
Business Acquisition, Contingent Consideration
Contingent consideration			$ 20,200,000	$ 22,200,000

Revenue Recognition - Narrative

Revenue Recognition - Narrative (Details) - USD ($)	3 Months Ended		6 Months Ended		18 Months Ended	51 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018	Mar. 31, 2019	Mar. 31, 2019	Dec. 31, 2018
Disaggregation of Revenue [Line Items]
Prior period performance obligation revenue recognized			$ 14,300,000	$ 15,700,000
Overpayment reimbursement liability	$ 30,500,000		30,500,000				$ 35,900,000
Revenue recognized		$ 4,800,000		8,500,000	$ 0
Total revenues	226,368,000	263,685,000	448,820,000	518,598,000
Contract liability	54,100,000		54,100,000				$ 91,100,000
Rayaldee
Disaggregation of Revenue [Line Items]
Revenue recognized	5,700,000		11,500,000
Total revenues			27,580,000
Transfer of intellectual property and other
Disaggregation of Revenue [Line Items]
Total revenues	19,230,000	19,107,000	37,490,000	34,855,000
Pfizer | Products
Disaggregation of Revenue [Line Items]
Revenue recognized						$ 0
Contract liability	47,500,000		47,500,000
Pfizer | Products | Transfer of intellectual property and other
Disaggregation of Revenue [Line Items]
Total revenues	$ 18,200,000	$ 16,300,000	$ 35,600,000	$ 31,000,000

Revenue Recognition - Schedule

Revenue Recognition - Schedule of Disaggregation of Revenue (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Disaggregation of Revenue [Line Items]
Total revenues	$ 226,368	$ 263,685	$ 448,820	$ 518,598
Services
Disaggregation of Revenue [Line Items]
Total revenues	178,458	216,055	357,349	427,369
Healthcare insurers
Disaggregation of Revenue [Line Items]
Total revenues	106,278	131,695	211,207	262,769
Government payers
Disaggregation of Revenue [Line Items]
Total revenues	28,634	38,860	59,037	75,103
Client payers
Disaggregation of Revenue [Line Items]
Total revenues	38,101	39,664	76,559	77,830
Patients
Disaggregation of Revenue [Line Items]
Total revenues	$ 5,445	$ 5,836	$ 10,546	$ 11,667

Revenue Recognition - Schedul_2

Revenue Recognition - Schedule of Product Sales Allowances and Accruals (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Provision related to current period sales			$ 200	$ 200
Total revenues	$ 226,368	$ 263,685	448,820	518,598
Rayaldee
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance			4,043
Provision related to current period sales			15,887
Adjustment related to prior period sales			202
Credits or payments made			(14,044)
Ending balance	6,088		6,088
Total revenues			$ 27,580
Provision for Rayaldee sales allowances and accruals as a percentage of gross Rayaldee sales			58.00%
Transfer of intellectual property and other
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Total revenues	19,230	19,107	$ 37,490	34,855
Chargebacks, discounts, rebates and fees | Rayaldee
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance			1,316
Provision related to current period sales			4,716
Adjustment related to prior period sales			(9)
Credits or payments made			(4,611)
Ending balance	1,412		1,412
Governmental | Rayaldee
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance			2,090
Provision related to current period sales			9,791
Adjustment related to prior period sales			211
Credits or payments made			(8,264)
Ending balance	3,828		3,828
Returns | Rayaldee
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Beginning balance			637
Provision related to current period sales			1,380
Adjustment related to prior period sales			0
Credits or payments made			(1,169)
Ending balance	848		848
Pfizer | Products | Transfer of intellectual property and other
Accounts Receivable, Allowance for Credit Loss [Roll Forward]
Total revenues	$ 18,200	$ 16,300	$ 35,600	$ 31,000

Strategic Alliances (Details)

Strategic Alliances (Details) - USD ($)

Oct. 12, 2017

Sep. 30, 2018

Jul. 31, 2018

May 31, 2016

Jan. 31, 2015

Dec. 31, 2010

Jun. 30, 2018

Jun. 30, 2019

Jun. 30, 2018

Mar. 31, 2019

Mar. 31, 2019

Sep. 30, 2018

Dec. 31, 2018

Mar. 31, 2013

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Upfront payment from development and license agreement

$ 6,000,000

Milestone revenue recognized

$ 4,800,000

$ 8,500,000

$ 0

Contract liability

$ 54,100,000

$ 91,100,000

VFMCRP | Development and License Agreement

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

License revenue, initial payment

$ 50,000,000

VFMCRP | Regulatory Milestones

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Additional milestone payment

$ 2,000,000

Additional milestone payment to be received

35,000,000

VFMCRP | Launch and Sales-based Milestones

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Additional milestone payment to be received

195,000,000

VFMCRP | Exclusive Option

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Additional milestone payment to be received

$ 555,000,000

Pfizer | Products

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Milestone revenue recognized

$ 0

Additional milestone payment to be received

$ 275,000,000

Non-refundable and non-creditable upfront payment

295,000,000

Contract liability

47,500,000

Tesaro

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Milestone revenue recognized

$ 0

$ 0

Additional milestone payment

$ 85,000,000

Upfront payment under license agreements

$ 6,000,000

Milestone payment received

$ 30,000,000

Period from first commercial sale

12 years

Written termination threshold

3 months

Minimum | Pfizer | Products

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Each milestone payment

20,000,000

Maximum | Pfizer | Products

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Each milestone payment

$ 90,000,000

Pharmsynthez

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Ownership percentage, equity method

9.00%

Phio Pharmaceuticals

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Maximum milestone payments to be received

$ 50,000,000

Phase Two Initiation

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Upfront payment from development and license agreement

$ 6,000,000

Regulatory and Development

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Milestone payment from development and license agreement

31,000,000

Sales Revenue

Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]

Milestone payment from development and license agreement

$ 75,000,000

Segments - Narrative (Details)

Segments - Narrative (Details)	6 Months Ended
	Jun. 30, 2019USD ($)Segment
Segment Reporting Information [Line Items]
Number of reportable segments | Segment	2
Intersegment Elimination
Segment Reporting Information [Line Items]
Inter-segment sales	$ 0
Inter-segment allocation of interest expense	$ 0

Segments - Operations and Asset

Segments - Operations and Assets Information (Details) - USD ($) $ in Thousands	3 Months Ended		6 Months Ended
	Jun. 30, 2019	Jun. 30, 2018	Jun. 30, 2019	Jun. 30, 2018	Dec. 31, 2018
Segment Reporting Information [Line Items]
Total revenues	$ 226,368	$ 263,685	$ 448,820	$ 518,598
Operating loss	(47,260)	(5,108)	(122,577)	(47,719)
Depreciation and amortization	23,661	24,762	47,477	49,518
Net income (loss) from investment in investees	(271)	(7,213)	(2,125)	(9,669)
Assets	2,456,228		2,456,228		$ 2,451,072
Goodwill	699,842		699,842		700,193
United States
Segment Reporting Information [Line Items]
Total revenues	184,310	222,535	369,203	437,845
Ireland
Segment Reporting Information [Line Items]
Total revenues	22,174	20,778	42,707	38,060
Chile
Segment Reporting Information [Line Items]
Total revenues	9,051	11,937	16,915	23,670
Spain
Segment Reporting Information [Line Items]
Total revenues	4,876	4,592	9,294	10,125
Israel
Segment Reporting Information [Line Items]
Total revenues	3,768	2,526	6,884	6,141
Mexico
Segment Reporting Information [Line Items]
Total revenues	2,058	1,302	3,589	2,723
Other
Segment Reporting Information [Line Items]
Total revenues	131	15	228	34
Corporate
Segment Reporting Information [Line Items]
Operating loss	(10,691)	(8,748)	(22,962)	(20,393)
Depreciation and amortization	19	21	39	51
Net income (loss) from investment in investees	0	0	0	0
Assets	78,217		78,217		52,413
Goodwill	0		0		0
Pharmaceutical | Operating Segments
Segment Reporting Information [Line Items]
Operating loss	(8,556)	2,165	(38,033)	(20,783)
Depreciation and amortization	7,382	6,752	14,908	13,492
Net income (loss) from investment in investees	(271)	(6,942)	(2,125)	(9,114)
Assets	1,239,338		1,239,338		1,236,499
Goodwill	247,055		247,055		247,407
Diagnostics | Operating Segments
Segment Reporting Information [Line Items]
Operating loss	(28,013)	1,475	(61,582)	(6,543)
Depreciation and amortization	16,260	17,989	32,530	35,975
Net income (loss) from investment in investees	0	(271)	0	(555)
Assets	1,138,673		1,138,673		1,162,160
Goodwill	452,787		452,787		$ 452,786
Services
Segment Reporting Information [Line Items]
Total revenues	178,458	216,055	357,349	427,369
Services | Corporate
Segment Reporting Information [Line Items]
Total revenues	0	0	0	0
Services | Pharmaceutical | Operating Segments
Segment Reporting Information [Line Items]
Total revenues	0	0	0	0
Services | Diagnostics | Operating Segments
Segment Reporting Information [Line Items]
Total revenues	178,458	216,055	357,349	427,369
Products
Segment Reporting Information [Line Items]
Total revenues	28,680	28,523	53,981	56,374
Products | Pharmaceutical | Operating Segments
Segment Reporting Information [Line Items]
Total revenues	28,680	28,523	53,981	56,374
Transfer of intellectual property and other
Segment Reporting Information [Line Items]
Total revenues	19,230	19,107	37,490	34,855
Transfer of intellectual property and other | Corporate
Segment Reporting Information [Line Items]
Total revenues	0	0	0	0
Transfer of intellectual property and other | Pharmaceutical | Operating Segments
Segment Reporting Information [Line Items]
Total revenues	19,230	19,107	37,490	34,855
Transfer of intellectual property and other | Diagnostics | Operating Segments
Segment Reporting Information [Line Items]
Total revenues	$ 0	$ 0	$ 0	$ 0

Leases - Lease Assets and Liabi

Leases - Lease Assets and Liabilities (Details) $ in Thousands	Jun. 30, 2019USD ($)
Assets
Operating lease assets	$ 29,640
Finance lease assets	7,681
Current
Operating lease liabilities	13,376
Accrued expenses	3,031
Long-term
Operating lease liabilities	16,673
Other long-term liabilities	$ 4,650
Weighted average remaining lease term
Operating leases	2 years 1 month 6 days
Finance leases	2 years 6 months
Weighted average discount rate
Operating leases	4.30%
Finance leases	4.50%

Leases - Lease Liability Maturi

Leases - Lease Liability Maturity (Details) $ in Thousands	Jun. 30, 2019USD ($)
Operating
July 1, 2019 through December 31, 2019	$ 7,968
2020	10,169
2021	6,678
2022	3,754
2023	2,329
Thereafter	2,096
Total undiscounted future minimum lease payments	32,994
Less: Difference between lease payments and discounted lease liabilities	2,945
Total lease liabilities	30,049
Finance
July 1, 2019 through December 31, 2019	1,661
2020	2,649
2021	1,938
2022	960
2023	368
Thereafter	419
Total undiscounted future minimum lease payments	7,995
Less: Difference between lease payments and discounted lease liabilities	314
Total lease liabilities	$ 7,681

Leases - Narrative (Details)

Leases - Narrative (Details) $ in Millions	6 Months Ended
	Jun. 30, 2019USD ($)
Leases [Abstract]
Operating lease expense	$ 9.8
Finance lease expense	2
Variable lease expense	$ 1.7

Leases - Lease Cash Flow Inform

Leases - Lease Cash Flow Information (Details) $ in Thousands	6 Months Ended
	Jun. 30, 2019USD ($)
Leases [Abstract]
Operating cash flows from operating leases	$ 10,804
Operating cash flows from finance leases	234
Financing cash flows from finance leases	1,590
Total	$ 12,628

Subsequent Events Subsequent Ev

Subsequent Events Subsequent Events (Details) - Subsequent Event	3 Months Ended
	Sep. 30, 2019
Minimum
Subsequent Event [Line Items]
Consecutive days	30 days
Maximum
Subsequent Event [Line Items]
Percentage of total revolving commitment	10.00%

Uncategorized Items - opk-63020

Label	Element	Value
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ 0
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	0
Retained Earnings [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	4,876,000
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	926,000
Additional Paid-in Capital [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	(926,000)
AOCI Attributable to Parent [Member]
Cumulative Effect of New Accounting Principle in Period of Adoption	us-gaap_CumulativeEffectOfNewAccountingPrincipleInPeriodOfAdoption	$ (4,876,000)