EXACT SCIENCES CORP, 10-Q filed on 11/3/2022
Quarterly Report
v3.22.2.2
Cover Page - shares
 9 Months Ended
Sep. 30, 2022
Nov. 02, 2022
Cover [Abstract]    
Document Type 10-Q  
Document Quarterly Report true  
Document Period End Date Sep. 30, 2022  
Document Transition Report false  
Entity File Number 001-35092  
Entity Registrant Name EXACT SCIENCES CORPORATION  
Entity Incorporation, State or Country Code DE  
Entity Tax Identification Number 02-0478229  
Entity Address, Address Line One 5505 Endeavor Lane  
Entity Address, City or Town Madison  
Entity Address, State or Province WI  
Entity Address, Postal Zip Code 53719  
City Area Code 608  
Local Phone Number 535-8815  
Title of 12(b) Security Common Stock, $0.01 par value per share  
Trading Symbol EXAS  
Security Exchange Name NASDAQ  
Entity Current Reporting Status Yes  
Entity Interactive Data Current Yes  
Entity Filer Category Large Accelerated Filer  
Entity Small Business false  
Entity Emerging Growth Company false  
Entity Shell Company false  
Entity Common Stock, Shares Outstanding   177,684,039
Document Fiscal Year Focus 2022  
Document Fiscal Period Focus Q3  
Entity Central Index Key 0001124140  
Amendment Flag false  
Current Fiscal Year End Date --12-31  
v3.22.2.2
Condensed Consolidated Balance Sheets - USD ($)
$ in Thousands
Sep. 30, 2022
Dec. 31, 2021
Current Assets:    
Cash and cash equivalents $ 235,306 $ 315,471
Marketable securities 433,808 715,005
Accounts receivable, net 189,206 216,645
Inventory 114,699 104,994
Prepaid expenses and other current assets 75,487 74,122
Total current assets 1,048,506 1,426,237
Long-term Assets:    
Property, plant and equipment, net 670,506 580,248
Operating lease right-of-use assets 175,945 174,225
Goodwill 2,345,180 2,335,172
Intangible assets, net 1,977,690 2,094,411
Other long-term assets, net 88,739 74,591
Total assets 6,306,566 6,684,884
Current Liabilities:    
Accounts payable 63,583 67,829
Accrued liabilities 307,990 398,556
Operating lease liabilities, current portion 27,054 19,710
Other current liabilities 25,049 30,973
Total current liabilities 423,676 517,068
Long-term Liabilities:    
Convertible notes, net 2,184,625 2,180,232
Long-term debt 50,000 0
Other long-term liabilities 354,998 417,782
Operating lease liabilities, less current portion 184,633 182,166
Total liabilities 3,197,932 3,297,248
Commitments and contingencies (Note 14)
Stockholders’ Equity:    
Preferred stock, $0.01 par value Authorized—5,000,000 shares issued and outstanding—no shares at September 30, 2022 and December 31, 2021 0 0
Common stock, $0.01 par value Authorized—400,000,000 shares issued and outstanding—177,253,533 and 173,674,067 shares at September 30, 2022 and December 31, 2021 1,774 1,738
Additional paid-in capital 6,255,211 6,028,861
Accumulated other comprehensive loss (11,070) (1,443)
Accumulated deficit (3,137,281) (2,641,520)
Total stockholders’ equity 3,108,634 3,387,636
Total liabilities and stockholders’ equity $ 6,306,566 $ 6,684,884
v3.22.2.2
Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares
Sep. 30, 2022
Dec. 31, 2021
Statement of Financial Position [Abstract]    
Preferred stock, par value (in dollars per share) $ 0.01 $ 0.01
Preferred stock, authorized (in shares) 5,000,000 5,000,000
Preferred stock, issued (in shares) 0 0
Preferred stock, outstanding (in shares) 0 0
Common stock, par value (in dollars per share) $ 0.01 $ 0.01
Common stock, authorized (in shares) 400,000,000 400,000,000
Common stock, issued (in shares) 177,253,533 173,674,067
Common stock, outstanding (in shares) 177,253,533 173,674,067
v3.22.2.2
Condensed Consolidated Statements of Operations - USD ($)
shares in Thousands, $ in Thousands
 3 Months Ended 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Sep. 30, 2022
Sep. 30, 2021
Income Statement [Abstract]        
Revenue $ 523,073 $ 456,379 $ 1,531,284 $ 1,293,275
Operating expenses        
Cost of sales (exclusive of amortization of acquired intangible assets) 147,937 115,738 427,242 339,699
Research and development 90,813 75,356 299,144 297,158
Sales and marketing 187,697 196,617 635,800 577,585
General and administrative 191,968 186,541 543,410 621,897
Amortization of acquired intangible assets 23,526 23,940 74,536 70,954
Impairment of long-lived assets 5,946 20,210 12,537 20,210
Total operating expenses 647,887 618,402 1,992,669 1,927,503
Other operating loss (13,244) 0 (13,244) 0
Loss from operations (138,058) (162,023) (474,629) (634,228)
Other income (expense)        
Investment income (loss), net (8,584) (4,093) (13,790) 30,524
Interest expense (5,235) (4,680) (14,224) (13,948)
Total other income (expense) (13,819) (8,773) (28,014) 16,576
Net loss before tax (151,877) (170,796) (502,643) (617,652)
Income tax benefit 3,116 3,858 6,882 242,638
Net loss $ (148,761) $ (166,938) $ (495,761) $ (375,014)
Net loss per share—basic (in usd per share) $ (0.84) $ (0.97) $ (2.82) $ (2.19)
Net loss per share—diluted (in usd per share) $ (0.84) $ (0.97) $ (2.82) $ (2.19)
Weighted average common shares outstanding—basic (in shares) 176,997 171,978 175,935 170,978
Weighted average common shares outstanding—diluted (in shares) 176,997 171,978 175,935 170,978
v3.22.2.2
Condensed Consolidated Statements of Comprehensive Loss - USD ($)
$ in Thousands
 3 Months Ended 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Sep. 30, 2022
Sep. 30, 2021
Statement of Comprehensive Income [Abstract]        
Net loss $ (148,761) $ (166,938) $ (495,761) $ (375,014)
Other comprehensive loss, before tax:        
Unrealized gain (loss) on available-for-sale investments 4 66 (6,451) (563)
Foreign currency translation loss (2,429) 0 (3,176) 0
Comprehensive loss, before tax (151,186) (166,872) (505,388) (375,577)
Income tax benefit related to items of other comprehensive loss 0 0 0 170
Comprehensive loss, net of tax $ (151,186) $ (166,872) $ (505,388) $ (375,407)
v3.22.2.2
Condensed Consolidated Statements of Stockholders' Equity - USD ($)
$ in Thousands
Total
Common Stock
Additional Paid-In Capital
Accumulated Other Comprehensive Loss
Accumulated Deficit​
Beginning balance (in shares) at Dec. 31, 2020   159,423,410      
Beginning balance at Dec. 31, 2020 $ 2,235,552 $ 1,595 $ 4,279,327 $ 526 $ (2,045,896)
Increase (Decrease) in Stockholders' Equity          
Settlement of convertible notes, net of tax (in shares)   344      
Settlement of convertible notes, net of tax 26   26    
Exercise of common stock options (in shares)   967,107      
Exercise of common stock options 8,759 $ 10 8,749    
Issuance of common stock to fund the Company's 401(k) match (in shares)   162,606      
Issuance of common stock to fund the Company's 401(k) match 22,934 $ 2 22,932    
Compensation expense related to issuance of stock options and restricted stock awards (in shares)   1,355,435      
Compensation expense related to issuance of stock options and restricted stock awards 158,252 $ 13 158,239    
Issuance of common stock for business combinations, net of issuance costs (in shares)   9,384,410      
Issuance of common stock for business combinations, net of issuance costs 1,254,798 $ 94 1,254,704    
Net loss (31,164)       (31,164)
Other comprehensive income (loss) (162)     (162)  
Ending balance (in shares) at Mar. 31, 2021   171,293,312      
Ending balance at Mar. 31, 2021 3,648,995 $ 1,714 5,723,977 364 (2,077,060)
Beginning balance (in shares) at Dec. 31, 2020   159,423,410      
Beginning balance at Dec. 31, 2020 2,235,552 $ 1,595 4,279,327 526 (2,045,896)
Increase (Decrease) in Stockholders' Equity          
Net loss (375,014)        
Ending balance (in shares) at Sep. 30, 2021   172,242,798      
Ending balance at Sep. 30, 2021 3,457,590 $ 1,723 5,876,644 133 (2,420,910)
Beginning balance (in shares) at Mar. 31, 2021   171,293,312      
Beginning balance at Mar. 31, 2021 3,648,995 $ 1,714 5,723,977 364 (2,077,060)
Increase (Decrease) in Stockholders' Equity          
Settlement of convertible notes, net of tax (in shares)   197      
Settlement of convertible notes, net of tax 14   14    
Exercise of common stock options (in shares)   140,478      
Exercise of common stock options 2,858 $ 1 2,857    
Compensation expense related to issuance of stock options and restricted stock awards (in shares)   121,575      
Compensation expense related to issuance of stock options and restricted stock awards 56,285 $ 2 56,283    
Issuance of common stock for business combinations, net of issuance costs (in shares)   126,026      
Issuance of common stock for business combinations, net of issuance costs 16,120 $ 1 16,119    
Purchase of employee stock purchase plan shares (in shares)   173,717      
Purchase of employee stock purchase plan shares 12,038 $ 2 12,036    
Net loss (176,912)       (176,912)
Other comprehensive income (loss) (297)     (297)  
Ending balance (in shares) at Jun. 30, 2021   171,855,305      
Ending balance at Jun. 30, 2021 3,559,101 $ 1,720 5,811,286 67 (2,253,972)
Increase (Decrease) in Stockholders' Equity          
Settlement of convertible notes, net of tax (in shares)   39      
Settlement of convertible notes, net of tax 3   3    
Exercise of common stock options (in shares)   100,474      
Exercise of common stock options 1,755 $ 1 1,754    
Compensation expense related to issuance of stock options and restricted stock awards (in shares)   286,980      
Compensation expense related to issuance of stock options and restricted stock awards 63,603 $ 2 63,601    
Net loss (166,938)       (166,938)
Other comprehensive income (loss) 66     66  
Ending balance (in shares) at Sep. 30, 2021   172,242,798      
Ending balance at Sep. 30, 2021 $ 3,457,590 $ 1,723 5,876,644 133 (2,420,910)
Beginning balance (in shares) at Dec. 31, 2021 173,674,067 173,674,067      
Beginning balance at Dec. 31, 2021 $ 3,387,636 $ 1,738 6,028,861 (1,443) (2,641,520)
Increase (Decrease) in Stockholders' Equity          
Exercise of common stock options (in shares)   485,537      
Exercise of common stock options 4,282 $ 5 4,277    
Compensation expense related to issuance of stock options and restricted stock awards (in shares)   1,391,797      
Compensation expense related to issuance of stock options and restricted stock awards 52,441 $ 14 52,427    
Other (in shares)   7      
Other (7)   (7)    
Net loss (180,937)       (180,937)
Other comprehensive income (loss) (5,204)     (5,204)  
Ending balance (in shares) at Mar. 31, 2022   175,551,408      
Ending balance at Mar. 31, 2022 $ 3,258,211 $ 1,757 6,085,558 (6,647) (2,822,457)
Beginning balance (in shares) at Dec. 31, 2021 173,674,067 173,674,067      
Beginning balance at Dec. 31, 2021 $ 3,387,636 $ 1,738 6,028,861 (1,443) (2,641,520)
Increase (Decrease) in Stockholders' Equity          
Net loss $ (495,761)        
Ending balance (in shares) at Sep. 30, 2022 177,253,533 177,253,533      
Ending balance at Sep. 30, 2022 $ 3,108,634 $ 1,774 6,255,211 (11,070) (3,137,281)
Beginning balance (in shares) at Mar. 31, 2022   175,551,408      
Beginning balance at Mar. 31, 2022 3,258,211 $ 1,757 6,085,558 (6,647) (2,822,457)
Increase (Decrease) in Stockholders' Equity          
Exercise of common stock options (in shares)   84,485      
Exercise of common stock options 743 $ 1 742    
Issuance of common stock to fund the Company's 401(k) match (in shares)   391,129      
Issuance of common stock to fund the Company's 401(k) match 29,202 $ 4 29,198    
Compensation expense related to issuance of stock options and restricted stock awards (in shares)   183,095      
Compensation expense related to issuance of stock options and restricted stock awards 58,932 $ 2 58,930    
Issuance of common stock for business combinations, net of issuance costs (in shares)   265,186      
Issuance of common stock for business combinations, net of issuance costs 14,790 $ 2 14,788    
Purchase of employee stock purchase plan shares (in shares)   326,131      
Purchase of employee stock purchase plan shares 15,529 $ 3 15,526    
Net loss (166,063)       (166,063)
Other comprehensive income (loss) (1,998)     (1,998)  
Ending balance (in shares) at Jun. 30, 2022   176,801,434      
Ending balance at Jun. 30, 2022 3,209,346 $ 1,769 6,204,742 (8,645) (2,988,520)
Increase (Decrease) in Stockholders' Equity          
Exercise of common stock options (in shares)   73,441      
Exercise of common stock options 941 $ 1 940    
Compensation expense related to issuance of stock options and restricted stock awards (in shares)   378,658      
Compensation expense related to issuance of stock options and restricted stock awards 49,533 $ 4 49,529    
Net loss (148,761)       (148,761)
Other comprehensive income (loss) $ (2,425)     (2,425)  
Ending balance (in shares) at Sep. 30, 2022 177,253,533 177,253,533      
Ending balance at Sep. 30, 2022 $ 3,108,634 $ 1,774 $ 6,255,211 $ (11,070) $ (3,137,281)
v3.22.2.2
Condensed Consolidated Statements of Stockholders' Equity (Parenthetical) - $ / shares
Sep. 30, 2022
Dec. 31, 2021
Sep. 30, 2021
Statement of Financial Position [Abstract]      
Common stock, par value (in dollars per share) $ 0.01 $ 0.01 $ 0.01
v3.22.2.2
Condensed Consolidated Statements of Cash Flows - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Cash flows from operating activities:    
Net loss $ (495,761) $ (375,014)
Adjustments to reconcile net loss to net cash used in operating activities:    
Depreciation 73,541 64,267
Loss on disposal of property, plant and equipment 2,083 928
Unrealized loss on equity investments 3,497 1,937
Deferred tax benefit (9,346) (248,716)
Stock-based compensation 160,906 197,180
Post-combination expense for acceleration of unvested equity 0 80,960
Realized (gain) loss on preferred stock investment 10,000 (30,500)
Amortization of deferred financing costs, convertible note debt discount and issuance costs, and other liabilities 5,273 4,948
Amortization of premium on short-term investments 1,795 3,265
Amortization of acquired intangible assets 74,536 70,954
Impairment of long-lived assets 12,537 20,210
Asset acquisition IPR&D expense 0 85,337
Loss on sale of asset 13,244 0
Remeasurement of contingent consideration (57,619) 10,986
Non-cash lease expense 24,452 18,347
Changes in assets and liabilities:    
Accounts receivable, net 27,968 (14,038)
Inventory, net (9,705) (1,091)
Operating lease liabilities (16,242) (11,834)
Accounts payable and accrued liabilities (89,268) 64,344
Other assets and liabilities (7,487) (20,134)
Net cash used in operating activities (275,596) (77,664)
Cash flows from investing activities:    
Purchases of marketable securities (102,438) (1,021,557)
Maturities and sales of marketable securities 377,440 424,830
Purchases of property, plant and equipment (141,586) (76,374)
Proceeds from sale of asset 25,000 0
Business combination, net of cash acquired and issuance costs 685 (415,549)
Asset acquisition 0 (58,073)
Investments in privately held companies (26,827) (13,555)
Other investing activities (49) (244)
Net cash provided by (used in) investing activities 132,225 (1,160,522)
Cash flows from financing activities:    
Proceeds from accounts receivable securitization facility 50,000 0
Proceeds from exercise of common stock options 5,966 13,372
Proceeds in connection with the Company’s employee stock purchase plan 15,529 12,038
Other financing activities (5,113) (4,742)
Net cash provided by financing activities 66,382 20,668
Effects of exchange rate changes on cash and cash equivalents (3,176) 0
Net decrease in cash, cash equivalents and restricted cash (80,165) (1,217,518)
Cash, cash equivalents and restricted cash, beginning of period 315,768 1,491,594
Cash, cash equivalents and restricted cash, end of period 235,603 274,076
Supplemental disclosure of non-cash investing and financing activities    
Property, plant and equipment acquired but not paid 23,659 21,110
Business combination contingent consideration liability 4,600 350,348
Supplemental disclosure of cash flow information:    
Interest paid 10,754 10,685
Reconciliation of cash, cash equivalents and restricted cash:    
Cash and cash equivalents 235,306 273,779
Restricted cash — included in prepaid expenses and other current assets as of September 30, 2022, and other long-term assets, net as of September 30, 2021 297 297
Total cash, cash equivalents and restricted cash $ 235,603 $ 274,076
v3.22.2.2
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
 9 Months Ended
Sep. 30, 2022
Accounting Policies [Abstract]  
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES
Business
Exact Sciences Corporation (together with its subsidiaries, “Exact,” or the “Company”) was incorporated in February 1995. Exact is a leading global cancer diagnostics company. It has developed some of the most impactful tests in cancer screening and diagnostics, including Cologuard® and Oncotype DX®. Exact is currently working on the development of additional tests, with the goal of bringing new, innovative cancer tests to patients throughout the world.
Basis of Presentation and Principles of Consolidation
The accompanying condensed consolidated financial statements, which include the accounts of Exact Sciences Corporation and those of its wholly owned subsidiaries and variable interest entities, are unaudited and have been prepared on a basis substantially consistent with the Company’s audited financial statements and notes as of and for the year ended December 31, 2021 included in the Company’s Annual Report on Form 10-K (the “2021 Form 10-K”). All intercompany transactions and balances have been eliminated upon consolidation. These condensed consolidated financial statements are prepared in conformity with accounting principles generally accepted in the United States of America (“GAAP”) and follow the requirements of the Securities and Exchange Commission (“SEC”) for interim reporting. In the opinion of management, the accompanying unaudited condensed consolidated financial statements contain all adjustments (consisting only of adjustments of a normal and recurring nature) considered necessary for a fair statement of its financial position, operating results and cash flows for the periods presented. The condensed consolidated balance sheet at December 31, 2021 has been derived from audited financial statements, but does not contain all of the footnote disclosures from the 2021 Form 10-K. The results of the Company’s operations for any interim period are not necessarily indicative of the results of the Company’s operations for any other interim period or for a full fiscal year. The statements should be read in conjunction with the audited financial statements and related notes included in the 2021 Form 10-K.
Use of Estimates
The preparation of the condensed consolidated 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. Critical accounting policies are those that affect the Company’s financial statements materially and involve difficult, subjective or complex judgments by management, and actual results could differ from those estimates. These estimates include revenue recognition, valuation of intangible assets and goodwill, and accounting for income taxes among others. The Company’s critical accounting policies and estimates are explained further in the notes to the condensed consolidated financial statements in this Quarterly Report and the 2021 Form 10-K.
The spread of the coronavirus (“COVID-19”) has affected many segments of the global economy, including the cancer screening and diagnostics industry. The Company assessed certain accounting matters that generally require consideration of forecasted financial information in context with the information reasonably available to the Company and the unknown future impacts of COVID-19 as of September 30, 2022 and through the date of the filing of this Quarterly Report on Form 10-Q. The accounting matters assessed included, but were not limited to, the Company’s allowance for doubtful accounts and credit losses, marketable and non-marketable investments, software, and the carrying value of the goodwill and other long-lived assets. The Company’s future assessment of the magnitude and duration of COVID-19, as well as other factors, could result in additional material impacts to the Company’s consolidated financial statements in future reporting periods.
The pandemic and related precautionary measures began to materially disrupt the Company's operations in March 2020 and may continue to disrupt the business for an unknown period of time. As a result, the pandemic had an impact on the Company’s revenues and operating results.
The ultimate impact of COVID-19 depends on factors beyond the Company’s knowledge or control, including the duration and severity of the outbreak, as well as third-party actions taken to contain its spread and mitigate its public health effects. As a result, the Company is unable to estimate the extent to which COVID-19 will negatively impact its financial results or liquidity.
Significant Accounting Policies
During the nine months ended September 30, 2022, there were no changes to the Company’s significant accounting policies as described in the Company’s 2021 Form 10-K, except as described in the Collateralized Debt Instruments and Recently Adopted Accounting Pronouncements sections below.
Collateralized Debt Instruments
Debt instruments that are collateralized by security interests in financial assets held by the Company are accounted for as a secured borrowing and therefore: (i) the asset balances pledged as collateral are included within the applicable balance sheet line item and the borrowings are included within long-term debt in the condensed consolidated balance sheet; (ii) interest expense is included within the condensed consolidated statements of operations; and (iii) in the case of collateralized accounts receivable, receipts from customers related to the underlying accounts receivable are reflected as operating cash flows, and (iv) borrowings and repayments under the collateralized loans are reflected as financing cash flows within the condensed consolidated statements of cash flows.
Reclassifications
Certain prior year amounts have been reclassified to conform to the current year presentation in the condensed consolidated financial statements and accompanying notes to the condensed consolidated financial statements.
Recent Accounting Pronouncements
Recently Adopted Accounting Pronouncements
In October 2021, The Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2021-08, Business Combinations (Topic 805). This update requires that an entity (acquirer) recognize and measure contract assets and contract liabilities acquired in a business combination in accordance with Accounting Standards Codification (“ASC”) 606. This differs from the current requirement to measure contract assets and contract liabilities acquired in a business combination at fair value. The amendments in this update should be applied prospectively, and are effective for fiscal years beginning after December 15, 2022, including interim periods within those fiscal years. Early adoption is permitted, including adoption in an interim period. The Company early adopted the amendments in this update during the first quarter of fiscal year 2022. There was no material impact to the Company’s condensed consolidated financial statements.
In June 2022, the FASB issued ASU No. 2022-03, Fair Value Measurement (Topic 820) – Fair Value Measurement of Equity Securities Subject to Contractual Sale Restrictions. This update clarifies that a contractual restriction on the sale of an equity security is not part of the unit of account of the security and should not be considered in measuring fair value. The update also provides that an entity cannot recognize and measure a contractual sale restriction as a separate unit of account. The amendments in this update should be applied prospectively, and are effective for fiscal years beginning after December 15, 2023, including interim periods within those fiscal years. Early adoption is permitted, including adoption in an interim period. The Company early adopted the amendments in this update during the third quarter of fiscal year 2022. There was no material impact to the Company’s condensed consolidated financial statements.
Net Loss Per Share
Basic net loss per common share was determined by dividing net loss applicable to common stockholders by the weighted average common shares outstanding during the period. Basic and diluted net loss per share is the same because all outstanding common stock equivalents have been excluded, as they are anti-dilutive as a result of the Company’s losses.
The following potentially issuable common shares were not included in the computation of diluted net loss per share because they would have an anti-dilutive effect due to net losses for each period:
September 30,
(In thousands)20222021
Shares issuable in connection with acquisitions45 45 
Shares issuable upon exercise of stock options1,588 2,380 
Shares issuable upon the release of restricted stock awards5,588 4,306 
Shares issuable upon the release of performance share units1,018 863 
Shares issuable upon conversion of convertible notes20,309 20,309 
28,548 27,903 
v3.22.2.2
REVENUE
 9 Months Ended
Sep. 30, 2022
Revenue from Contract with Customer [Abstract]  
REVENUE REVENUE
The Company’s revenue is primarily generated by its laboratory testing services utilizing its Cologuard, Oncotype®, and COVID-19 tests. The services are completed upon release of a patient’s test result to the ordering healthcare provider.
Disaggregation of Revenue
The following table presents the Company’s revenues disaggregated by revenue source:
Three Months Ended September 30,Nine Months Ended September 30,
(In thousands)2022202120222021
Screening
Medicare Parts B & C$140,366 $116,088 $389,373 $329,034 
Commercial188,923 151,245 531,789 419,268 
Other31,470 13,045 100,013 36,341 
Total Screening360,759 280,378 1,021,175 784,643 
Precision Oncology
Medicare Parts B & C$47,038 $51,607 $152,224 $144,753 
Commercial42,660 42,844 134,658 136,800 
International31,533 27,229 89,536 80,133 
Other30,212 23,732 81,640 50,942 
Total Precision Oncology151,443 145,412 458,058 412,628 
COVID-19 Testing$10,871 $30,589 $52,051 $96,004 
Total$523,073 $456,379 $1,531,284 $1,293,275 
Screening revenue primarily includes laboratory service revenue from Cologuard and PreventionGenetics LLC (“PreventionGenetics”) tests while Precision Oncology revenue includes laboratory service revenue from global Oncotype products and therapy selection products, including OncomapTM and Oncomap ExTraTM.
At each reporting period end, the Company conducts an analysis of the estimates used to calculate the transaction price to determine whether any new information available impacts those estimates made in prior reporting periods. The Company recognized revenue from a change in transaction price of $6.4 million and $17.6 million for the three and nine months ended September 30, 2022, respectively. The Company recorded a downward adjustment to revenue from a change in transaction price of $0.2 million and $13.2 million for the three and nine months ended September 30, 2021, respectively.
The Company had deferred revenue of $2.3 million and $1.0 million as of September 30, 2022 and December 31, 2021, respectively. Deferred revenue is reported in other current liabilities in the Company’s condensed consolidated balance sheets.
Revenue recognized for the three months and nine months ended September 30, 2022, which was included in the deferred revenue balance at the beginning of each period, was not significant. Revenue recognized for the three months and nine months ended September 30, 2021, which was included in the deferred revenue balance at the beginning of each period, was $0.2 million and $24.6 million, respectively. Of the $24.6 million of revenue recognized for the nine months ended September 30, 2021, $24.3 million related to COVID-19 testing.
v3.22.2.2
MARKETABLE SECURITIES
 9 Months Ended
Sep. 30, 2022
Cash and Cash Equivalents [Abstract]  
MARKETABLE SECURITIES MARKETABLE SECURITIES
The following table sets forth the Company’s cash, cash equivalents, and marketable securities at September 30, 2022 and December 31, 2021:
(In thousands)September 30, 2022December 31, 2021
Cash and cash equivalents
Cash and money market$173,968 $247,335 
Cash equivalents61,338 68,136 
Total cash and cash equivalents235,306 315,471 
Marketable securities
Available-for-sale debt securities$428,421 $711,669 
Equity securities5,387 3,336 
Total marketable securities433,808 715,005 
Total cash, cash equivalents and marketable securities$669,114 $1,030,476 
Available-for-sale debt securities, including the classification within the condensed consolidated balance sheet at September 30, 2022, consisted of the following:
(In thousands)Amortized CostGains in Accumulated Other Comprehensive Income (Loss) (1)Losses in Accumulated Other Comprehensive Income (Loss) (1)Estimated Fair Value
Cash equivalents
Commercial paper$58,917 $— $— $58,917 
U.S. government agency securities2,421 — — 2,421 
Total cash equivalents61,338 — — 61,338 
Marketable securities
Corporate bonds$116,627 $— $(2,423)$114,204 
U.S. government agency securities248,351 — (4,496)243,855 
Certificates of deposit5,500 — — 5,500 
Commercial paper1,988 — — 1,988 
Asset backed securities63,872 — (998)62,874 
Total marketable securities436,338 — (7,917)428,421 
Total available-for-sale securities$497,676 $— $(7,917)$489,759 
______________
(1)Gains and losses in accumulated other comprehensive income (loss) (“AOCI”) are reported before tax impact.
Available-for-sale debt securities, including the classification within the condensed consolidated balance sheet at December 31, 2021, consisted of the following:
(In thousands)Amortized CostGains in Accumulated Other Comprehensive Income (Loss) (1) Losses in Accumulated Other Comprehensive Income (Loss) (1)Estimated Fair Value
Cash equivalents
U.S. government agency securities$3,543 $— $— $3,543 
Commercial paper64,593 — — 64,593 
Total cash equivalents68,136 — — 68,136 
Marketable securities
U.S. government agency securities$250,793 $— $(873)$249,920 
Asset backed securities94,565 2 (107)94,460 
Commercial paper6,996 — — 6,996 
Certificates of deposit47,147 2 (10)47,139 
Corporate bonds313,634 13 (493)313,154 
Total marketable securities713,135 17 (1,483)711,669 
Total available-for-sale securities$781,271 $17 $(1,483)$779,805 
______________
(1)Gains and losses in AOCI are reported before tax impact.
The following table summarizes contractual underlying maturities of the Company’s available-for-sale debt securities at September 30, 2022:
Due one year or lessDue after one year through five years
(In thousands)CostFair ValueCostFair Value
Cash equivalents
Commercial paper$58,917 $58,917 $— $— 
U.S. government agency securities2,421 2,421 — — 
Total cash equivalents61,338 61,338 — — 
Marketable securities
U.S. government agency securities$238,617 $234,274 $9,734 $9,581 
Corporate bonds93,666 92,032 22,961 22,172 
Certificates of deposit5,500 5,500 — — 
Asset backed securities— — 63,872 62,874 
Commercial paper1,988 1,988 — — 
Total marketable securities339,771 333,794 96,567 94,627 
Total available-for-sale securities$401,109 $395,132 $96,567 $94,627 
The following table summarizes the gross unrealized losses and fair values of available-for-sale debt securities in an unrealized loss position as of September 30, 2022, aggregated by investment category and length of time those individual securities have been in a continuous unrealized loss position:
Less than one yearOne year or greaterTotal
(In thousands)Fair ValueGross Unrealized LossFair ValueGross Unrealized LossFair ValueGross Unrealized Loss
Marketable securities
Corporate bonds$114,204 $(2,423)$— $— $114,204 $(2,423)
Asset backed securities61,924 (998)— — 61,924 (998)
U.S. government agency securities243,855 (4,496)— — 243,855 (4,496)
Total available-for-sale securities$419,983 $(7,917)$— $— $419,983 $(7,917)
The Company evaluates investments that are in an unrealized loss position for impairment as a result of credit loss. It was determined that no credit losses exist as of September 30, 2022 and December 31, 2021, because the change in market value for those securities in an unrealized loss position has resulted from fluctuating interest rates rather than a deterioration of the credit worthiness of the issuers.
The gains and losses recorded on available-for-sale debt securities and equity securities are included in investment income, net in the Company’s condensed consolidated statements of operations. The gains and losses recorded were not significant for the three and nine months ended September 30, 2022 and 2021.
v3.22.2.2
INVENTORY
 9 Months Ended
Sep. 30, 2022
Inventory Disclosure [Abstract]  
INVENTORY INVENTORY
Inventory consisted of the following:
(In thousands)September 30, 2022December 31, 2021
Raw materials$56,829 $51,321 
Semi-finished and finished goods57,870 53,673 
Total inventory$114,699 $104,994 
v3.22.2.2
PROPERTY, PLANT AND EQUIPMENT
 9 Months Ended
Sep. 30, 2022
Property, Plant and Equipment [Abstract]  
PROPERTY, PLANT AND EQUIPMENT PROPERTY, PLANT AND EQUIPMENT
The carrying value and estimated useful lives of property, plant and equipment are as follows:
(In thousands)Estimated Useful LifeSeptember 30, 2022December 31, 2021
Property, plant and equipment
Landn/a$4,716 $4,716 
Leasehold and building improvements(1)179,025 147,083 
Land improvements15 years6,415 5,206 
Buildings
30 - 40 years
271,858 210,560 
Computer equipment and computer software3 years132,416 109,119 
Laboratory equipment
3 - 10 years
232,189 189,748 
Furniture and fixtures
3 - 10 years
33,641 28,293 
Assets under constructionn/a93,687 100,339 
Property, plant and equipment, at cost953,947 795,064 
Accumulated depreciation(283,441)(214,816)
Property, plant and equipment, net$670,506 $580,248 
______________
(1)Lesser of remaining lease term, building life, or estimated useful life.
Depreciation expense for the three months ended September 30, 2022 and 2021 was $25.0 million and $22.3 million, respectively. Depreciation expense for the nine months ended September 30, 2022 and 2021 was $73.5 million and $64.3 million, respectively.
At September 30, 2022, the Company had $93.7 million of assets under construction, which consisted of $38.9 million in laboratory equipment, $28.8 million related to buildings, $16.1 million in leasehold and building improvements, and $9.9 million in capitalized costs related to software projects. Depreciation will begin on these assets once they are placed into service upon completion.
v3.22.2.2
INTANGIBLE ASSETS AND GOODWILL
 9 Months Ended
Sep. 30, 2022
Goodwill and Intangible Assets Disclosure [Abstract]  
INTANGIBLE ASSETS AND GOODWILL INTANGIBLE ASSETS AND GOODWILL
Intangible Assets
The following table summarizes the net-book-value and estimated remaining life of the Company’s intangible assets as of September 30, 2022:
(In thousands)Weighted Average Remaining Life (Years)Gross Carrying AmountAccumulated Amortization
Net Balance at September 30, 2022
Finite-lived intangible assets
Trade name12.7$104,000 $(18,840)$85,160 
Customer relationships8.34,000 (333)3,667 
Patents and licenses3.110,942 (7,805)3,137 
Acquired developed technology (1)7.9860,610 (224,884)635,726 
Total finite-lived intangible assets979,552 (251,862)727,690 
In-process research and developmentn/a1,250,000 — 1,250,000 
Total intangible assets$2,229,552 $(251,862)$1,977,690 
______________
(1)The gross carrying amount includes an immaterial foreign currency translation adjustment related to the intangible assets acquired as a result of the acquisition of OmicEra Diagnostics GmbH (“OmicEra”), whose functional currency is also its local currency. Intangible asset balances are translated into U.S. dollars using exchange rates in effect at period end, and adjustments related to foreign currency translation are included in other comprehensive income.
The following table summarizes the net-book-value and estimated remaining life of the Company’s intangible assets as of December 31, 2021:
(In thousands)Weighted Average Remaining Life (Years)Gross Carrying AmountAccumulated Amortization
Net balance at December 31, 2021
Finite-lived intangible assets
Trade name13.4$104,700 $(13,554)$91,146 
Customer relationships9.66,700 (1,577)5,123 
Patents and licenses3.610,942 (6,763)4,179 
Acquired developed technology8.6918,171 (176,402)741,769 
Supply agreements5.42,295 (101)2,194 
Total finite-lived intangible assets1,042,808 (198,397)844,411 
In-process research and developmentn/a1,250,000 — 1,250,000 
Total intangible assets$2,292,808 $(198,397)$2,094,411 
As of September 30, 2022, the estimated future amortization expense associated with the Company’s finite-lived intangible assets for each of the five succeeding fiscal years is as follows:
(In thousands)
2022 (remaining three months)$22,913 
202391,653 
202491,319 
202590,271 
202689,211 
Thereafter342,323 
$727,690 
The Company’s acquired intangible assets are being amortized on a straight-line basis over the estimated useful life.
On August 2, 2022, the Company completed a sale of the developed technology intangible asset related to the Oncotype DX Genomic Prostate Score® test (“GPS test”) to MDxHealth SA (“MDxHealth”), which was measured using the income approach to determine the fair value. The gross value of the intangible asset was $59.0 million with accumulated amortization of $16.1 million as of the closing date, resulting in a carrying value of $42.9 million, which was derecognized from intangible assets, net in the condensed consolidated balance sheets upon completion of the divestiture. Refer to Note 16 for further information on this sale.
During the third quarter of 2022, the Company recorded a non-cash, pre-tax impairment loss of $2.0 million related to the supply agreement intangible asset that was initially recorded as part of the combination with Genomic Health due to the termination of the agreement, which reduced the carrying value to zero.
During the second quarter of 2022, the Company recorded a non-cash, pre-tax impairment loss of $6.6 million related to the acquired developed technology intangible asset acquired as a result of the acquisition of Paradigm Diagnostics, Inc. due to lower than anticipated performance of the underlying product.
During the third quarter of 2021, the Company recorded a non-cash, pre-tax impairment loss of $20.2 million related to the supply agreement intangible asset that was initially recorded as part of the combination with Genomic Health due to lower than anticipated performance of the underlying product. The Company utilized the income approach to measure the fair value of the supply agreement, which involves significant unobservable inputs (Level 3 inputs).
The impairment charges recorded are included in impairment of long-lived assets in the condensed consolidated statement of operations.
Goodwill
The change in the carrying amount of goodwill for the periods ended September 30, 2022 and December 31, 2021 is as follows:
(In thousands)
Balance, January 1, 2021
$1,237,672 
Thrive acquisition948,105 
Ashion acquisition56,758 
PreventionGenetics acquisition92,637 
Balance, December 31, 2021
2,335,172 
OmicEra acquisition10,809 
PreventionGenetics acquisition adjustment42 
Effects of changes in foreign currency exchange rates (1)(843)
Balance September 30, 2022
$2,345,180 
______________
(1)Represents the impact of foreign currency translation related to the goodwill acquired as a result of the acquisition of OmicEra. Goodwill balances are translated into U.S. dollars using exchange rates in effect at period end, and adjustments related to foreign currency translation are included in other comprehensive income.
There were no impairment losses for the three and nine months ended September 30, 2022 and 2021.
v3.22.2.2
FAIR VALUE MEASUREMENTS
 9 Months Ended
Sep. 30, 2022
Fair Value Disclosures [Abstract]  
FAIR VALUE MEASUREMENTS FAIR VALUE MEASUREMENTS
The three levels of the fair value hierarchy established are as follows:
Level 1    Quoted prices (unadjusted) in active markets for identical assets or liabilities that the Company has the ability to access as of the reporting date. Active markets are those in which transactions for the asset or liability occur in sufficient frequency and volume to provide pricing information on an ongoing basis.
Level 2    Pricing inputs other than quoted prices in active markets included in Level 1, which are either directly or indirectly observable as of the reporting date. These include quoted prices for similar assets or liabilities in active markets and quoted prices for identical or similar assets or liabilities in markets that are not active.
Level 3    Unobservable inputs that reflect the Company’s assumptions about the assumptions that market participants would use in pricing the asset or liability. Unobservable inputs shall be used to measure fair value to the extent that observable inputs are not available.
The following table presents the Company’s fair value measurements as of September 30, 2022 along with the level within the fair value hierarchy in which the fair value measurements, in their entirety, fall.
(In thousands)Fair Value at September 30, 2022Quoted Prices in Active Markets for Identical Assets (Level 1)Significant Other Observable Inputs (Level 2)Significant Unobservable Inputs (Level 3)
Cash, cash equivalents, and restricted cash
Cash and money market$173,968 $173,968 $— $— 
Commercial paper58,917 — 58,917 — 
U.S. government agency securities2,421 — 2,421 — 
Restricted cash297 297 — — 
Marketable securities
Corporate bonds$114,204 $— $114,204 $— 
Certificates of deposit5,500 — 5,500 — 
Commercial paper1,988 — 1,988 — 
U.S. government agency securities243,855 — 243,855 — 
Asset backed securities62,874 — 62,874 — 
Equity securities (1)5,387 5,387 — — 
Non-marketable securities$2,990 $— $— $2,990 
Liabilities
Contingent consideration$(305,925)$— $— $(305,925)
Total$366,476 $179,652 $489,759 $(302,935)
______________
(1)Inclusive of the American Depository Shares of MDxHealth received as part of the sale of the Company’s GPS test, which are restricted to a holding period of six months after the date of the sale of August 2, 2022. The shares have a fair value of $4.7 million as of September 30, 2022.
The following table presents the Company’s fair value measurements as of December 31, 2021 along with the level within the fair value hierarchy in which the fair value measurements, in their entirety, fall.
(In thousands)Fair Value at December 31, 2021Quoted Prices in Active Markets for Identical Assets (Level 1)Significant Other Observable Inputs (Level 2)Significant Unobservable Inputs (Level 3)
Cash and cash equivalents
Cash and money market$247,335 $247,335 $— $— 
Commercial paper64,593 — 64,593 — 
U.S. government agency securities3,543 — 3,543 — 
Restricted cash297 297 — — 
Marketable securities
U.S. government agency securities$249,920 $— $249,920 $— 
Corporate bonds313,154 — 313,154 — 
Asset backed securities94,460 — 94,460 — 
Certificates of deposit47,139 — 47,139 — 
Commercial paper6,996 — 6,996 — 
Equity securities3,336 3,336 — — 
Non-marketable securities$3,090 $— $— $3,090 
Liabilities
Contingent consideration$(359,021)$— $— $(359,021)
Total$674,842 $250,968 $779,805 $(355,931)
There have been no changes in valuation techniques or transfers between fair value measurement levels during the three and nine months ended September 30, 2022. The fair value of Level 2 instruments classified as cash equivalents and marketable debt securities are valued using a third-party pricing agency where the valuation is based on observable inputs including pricing for similar assets and other observable market factors.
Contingent Consideration
The fair value of contingent consideration as of September 30, 2022 and December 31, 2021 was $305.9 million and $359.0 million, respectively, which was recorded in other long-term liabilities in the condensed consolidated balance sheets.
The following table provides a reconciliation of the beginning and ending balances of contingent consideration:
(In thousands)Contingent Consideration
Beginning balance, January 1, 2022$359,021 
Purchase price contingent consideration (1)4,600 
Changes in fair value(57,619)
Payments(77)
Ending balance, September 30, 2022
$305,925 
______________
(1)The increase in contingent consideration liability is due to the contingent consideration associated with the acquisition of OmicEra. Refer to Note 16 for further information.
This fair value measurement of contingent consideration is categorized as a Level 3 liability, as the measurement amount is based primarily on significant inputs not observable in the market.
The fair value of the contingent consideration liability recorded related to regulatory and product development milestones associated with the acquisitions of Thrive Earlier Detection Corporation (“Thrive”), Ashion Analytics, LLC (“Ashion”), and OmicEra acquisitions was $304.8 million and $357.8 million as of September 30, 2022 and December 31, 2021, respectively. The Company evaluates the fair value of the expected contingent consideration and the corresponding liability related to the regulatory and product development milestones using the probability-weighted scenario based discounted cash flow model, which is consistent with the initial measurement of the expected contingent consideration liabilities. Probabilities of success are applied to each potential scenario and the resulting values are discounted using a present-value factor. The passage of time in addition to changes in projected milestone achievement timing, present-value factor, the degree of achievement, if applicable, and probabilities of success may result in adjustments to the fair value measurement. The fair value of the contingent consideration liability recorded related to regulatory and product development milestones was determined using a weighted average probability of success of 91% as of September 30, 2022 and December 31, 2021, and a weighted average present-value factor of 7.1% and 2.3% as of September 30, 2022 and December 31, 2021, respectively. The projected fiscal year of payment range is from 2024 to 2027. Unobservable inputs were weighted by the relative fair value of the contingent consideration liability.
The fair value of the contingent consideration earnout liability related to certain revenue milestones associated with the Biomatrica acquisition was $1.2 million as of September 30, 2022 and December 31, 2021. The revenue milestone associated with the Ashion acquisition is not expected to be achieved and therefore no liability has been recorded for this milestone.
Non-Marketable Equity Investments
As of September 30, 2022 and December 31, 2021, the aggregate carrying amounts of the Company’s non-marketable equity securities without readily determinable fair values were $39.5 million and $25.3 million, respectively, which are classified as a component of other long-term assets, net in the Company’s condensed consolidated balance sheets. Since initial recognition of these investments, there have been no material upward or downward adjustments as a result of observable price changes. During the third quarter of 2022, the Company determined that one of its investments was fully impaired and recorded a $10.0 million realized loss.
The Company has committed capital to venture capital investment funds (the “Funds”) of $17.5 million, of which $14.2 million remained callable through 2033 as of September 30, 2022. The aggregate carrying amount of the Funds, which are classified as a component of other long-term assets, net in the Company’s condensed consolidated balance sheets, were $3.4 million and $1.5 million as of September 30, 2022 and December 31, 2021, respectively.
Derivative Financial Instruments
The Company enters into foreign currency forward contracts on the last day of each month to mitigate the impact of adverse movements in foreign exchange rates related to the remeasurement of monetary assets and liabilities and hedge the Company’s foreign currency exchange rate exposure. As of September 30, 2022 and December 31, 2021, the Company had open foreign currency forward contracts with notional amounts of $29.7 million and $46.7 million, respectively. The Company's foreign exchange derivative instruments are classified as Level 2 within the fair value hierarchy as they are valued using inputs that are observable in the market or can be derived principally from or corroborated by observable market data. The fair value of the open foreign currency forward contracts was zero at September 30, 2022 and December 31, 2021, and there were no gains or losses recorded to adjust the fair value of the open foreign currency contract held as of September 30, 2022. The contracts are closed subsequent to each month-end, and the gains and losses recorded from the contracts were not material for the three and nine months ended September 30, 2022 and 2021.
v3.22.2.2
LONG-TERM DEBT
 9 Months Ended
Sep. 30, 2022
Debt Disclosure [Abstract]  
LONG-TERM DEBT LONG-TERM DEBT
Accounts Receivable Securitization Facility
On June 29, 2022, the Company, through a wholly-owned special purpose entity, Exact Receivables LLC (“Exact Receivables”) entered into an accounts receivable securitization program (the “Securitization Facility”) with PNC Bank, National Association (“PNC”), with a scheduled maturity date of June 29, 2024. The Securitization Facility provides Exact Receivables with a revolving line-of-credit of up to $150.0 million of borrowing capacity, subject to certain borrowing base requirements, by collateralizing a security interest in the domestic customer accounts receivable of certain wholly-owned subsidiaries of the Company. The amount available under the Securitization Facility fluctuates over time based on the total amount of eligible customer accounts receivable generated by the Company during the normal course of operations. The Securitization Facility requires the Company to maintain minimum borrowings under the facility of $50.0 million. The debt issuance costs incurred related to the Securitization Facility were not material and are being amortized over the life of the Securitization Facility through interest expense within the condensed consolidated statements of operations.
In connection with the Securitization Facility, the Company also entered into two Receivables Purchase Agreements (“Receivable Purchase Agreements”) on June 29, 2022. The Receivable Purchase Agreements are among the Company and certain wholly-owned subsidiaries of the Company, and between the Company and Exact Receivables. Under the agreements, the wholly-owned subsidiaries sell all of their right, title and interest of their accounts receivable to Exact Receivables. The receivables are used to collateralize borrowings made under the Securitization Facility. The Company retains the responsibility of servicing the accounts receivable balances pledged as collateral under the Securitization Facility and provides a performance guaranty.
As of September 30, 2022, the eligible borrowing base under the Securitization Facility was $99.7 million of which the Company elected to collateralize $50.0 million. As of September 30, 2022, the Company had an outstanding balance of $50.0 million, which is recorded to long-term debt on the Company’s condensed consolidated balance sheets. The outstanding balance accrues interest at a rate equal to a daily secured overnight financing rate (“SOFR”) rate plus a SOFR adjustment and an applicable margin. The interest rate was 4.59% at September 30, 2022.
Revolving Loan Agreement
During November 2021, the Company entered into a revolving loan agreement (the “Revolving Loan Agreement”) with PNC. The Revolving Loan Agreement provides the Company with a revolving line of credit of up to $150.0 million (the “Revolver”). The Revolver is collateralized by the Company’s marketable securities held by PNC, which must continue to maintain a minimum market value of $150.0 million. The Revolver is available for general working capital purposes and all other lawful corporate purposes. In addition, the Company may request, in lieu of cash advances, letters of credit with an aggregate stated amount outstanding not to exceed $20.0 million. The availability of advances under the line of credit will be reduced by the stated amount of each letter of credit issued and outstanding.
Borrowings under the Revolving Loan Agreement accrue interest at an annual rate equal to the sum of the daily Bloomberg Short-Term Bank Yield Index Rate plus the applicable margin of 0.60%. Loans under the Revolving Loan Agreement may be prepaid at any time without penalty. The maturity date under the Revolving Loan Agreement was November 5, 2023. In October 2022 the Revolving Loan Agreement was amended to extend the maturity date to November 5, 2025. There were no other amendments to the Revolver.
The Company has agreed to various financial covenants under the Revolving Loan Agreement, and as of September 30, 2022, the Company is in compliance with all covenants.
During the fourth quarter of 2021, PNC issued a letter of credit of $2.9 million, which reduced the amount available for cash advances under the line of credit to $147.1 million as of September 30, 2022 and December 31, 2021. As of September 30, 2022 and December 31, 2021, the Company has not drawn funds from, nor are any amounts outstanding under, the Revolving Loan Agreement.
v3.22.2.2
CONVERTIBLE NOTES
 9 Months Ended
Sep. 30, 2022
CONVERTIBLE NOTES [Abstract]  
CONVERTIBLE NOTES CONVERTIBLE NOTES
Convertible note obligations included in the condensed consolidated balance sheet consisted of the following as of September 30, 2022:
Fair Value (1)
(In thousands)Principal AmountUnamortized Debt Discount and Issuance CostsNet Carrying AmountAmountLeveling
2028 Convertible notes - 0.375%
$1,150,000 $(16,545)$1,133,455 $733,999 2
2027 Convertible notes - 0.375%
747,500 (10,011)737,489 521,987 2
2025 Convertible notes - 1.000%
315,005 (1,324)313,681 281,142 2
Convertible note obligations included in the condensed consolidated balance sheet consisted of the following as of December 31, 2021:
Fair Value (1)
(In thousands)Principal AmountUnamortized Debt Discount and Issuance CostsNet Carrying AmountAmountLeveling
2028 Convertible notes - 0.375%
$1,150,000 $(18,826)$1,131,174 $1,139,650 2
2027 Convertible notes - 0.375%
747,500 (11,691)735,809 771,794 2
2025 Convertible notes - 1.000%
315,005 (1,756)313,249 415,473 2
______________
(1)The fair values are based on observable market prices for this debt, which is traded in less active markets and therefore is classified as a Level 2 fair value measurement.
Summary of Conversion Features
Until the six-months immediately preceding the maturity date of the applicable series of the Company’s convertible notes (the “Notes”), each series of Notes is convertible only upon the occurrence of certain events and during certain periods, as set forth in the Indentures filed at the time of the original offerings. On or after the date that is six-months immediately preceding the maturity date of the applicable series of Notes until the close of business on the second scheduled trading day immediately preceding the maturity date, holders may convert such Notes at any time. The Notes will be convertible into cash, shares of the Company’s common stock (plus, if applicable, cash in lieu of any fractional share), or a combination of cash and shares of the Company’s common stock, at the Company’s election.
It is the Company’s intent and policy to settle all conversions through combination settlement. The initial conversion rate is 13.26, 8.96, and 8.21 shares of common stock per $1,000 principal amount for the convertible notes due in 2025 (“2025 Notes”), 2027 (“2027 Notes”), and 2028 (“2028 Notes”), respectively, which is equivalent to an initial conversion price of approximately $75.43, $111.66, and $121.84 per share of the Company’s common stock for the 2025 Notes, 2027 Notes, and 2028 Notes, respectively. The 2025 Notes, 2027 Notes, and 2028 Notes are potentially convertible into up to 4.2 million, 6.7 million, and 9.4 million shares, respectively. The conversion rate is subject to adjustment upon the occurrence of certain specified events as set forth in the Indentures filed at the time of the original offerings but will not be adjusted for accrued and unpaid interest. In addition, holders of the Notes who convert their Notes in connection with a “make-whole fundamental change” (as defined in the Indenture), will, under certain circumstances, be entitled to an increase in the conversion rate.
If the Company undergoes a “fundamental change” (as defined in the Indenture), holders of the Notes may require the Company to repurchase for cash all or part 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.
Based on the closing price of the Company’s common stock of $32.49 on September 30, 2022, the if-converted values on the Notes do not exceed the principal amount.
The Notes do not contain any financial or operating covenants or any restrictions on the payment of dividends, the issuance of other indebtedness or the issuance or repurchase of securities by the Company.
Ranking of Convertible Notes
The Notes are the Company’s senior unsecured obligations and (i) rank senior in right of payment to all of its future indebtedness that is expressly subordinated in right of payment to the Notes; (ii) rank equal in right of payment to each outstanding series thereof and to all of the Company’s future liabilities that are not so subordinated, unsecured indebtedness; (iii) are effectively junior to all of the Company’s existing and future secured indebtedness and other secured obligations, to the extent of the value of the assets securing that indebtedness and other secured obligations; and (iv) are structurally subordinated to all indebtedness and other liabilities of the Company’s subsidiaries.
Issuance Costs
Issuance costs are amortized to interest expense over the term of the Notes. The following table summarizes the original issuance costs at the time of issuance for each set of Notes:
(In thousands)
January 2025 Notes$10,284 
June 2025 Notes7,362 
2027 Notes14,285 
2028 Notes24,453 
Interest Expense
Interest expense includes the following:
Three Months Ended September 30,Nine Months Ended September 30,
(In thousands)2022202120222021
Debt issuance costs amortization$1,444 $1,444 $4,284 $4,284 
Debt discount amortization37 37 110 110 
Coupon interest expense2,566 2,566 7,699 7,699 
Total interest expense on convertible notes$4,047 $4,047 $12,093 $12,093 
The following table summarizes the effective interest rates of the Notes:
Three Months Ended September 30,Nine Months Ended September 30,
2022202120222021
2025 Convertible Notes1.18 %1.18 %1.18 %1.18 %
2027 Convertible Notes0.68 %0.68 %0.67 %0.67 %
2028 Convertible Notes0.64 %0.64 %0.64 %0.64 %
The remaining period over which the unamortized debt discount will be recognized as non-cash interest expense is 2.30, 4.46, and 5.42 years for the 2025 Notes, 2027 Notes, and 2028 Notes, respectively.
v3.22.2.2
LICENSE AND COLLABORATION AGREEMENTS
 9 Months Ended
Sep. 30, 2022
LICENSE AGREEMENTS [Abstract]  
LICENSE AND COLLABORATION AGREEMENTS LICENSE AND COLLABORATION AGREEMENTSThe Company licenses certain technologies that are, or may be, incorporated into its technology under several license agreements, as well as the rights to commercialize certain diagnostic tests through collaboration agreements. Generally, the license agreements require the Company to pay single-digit royalties based on net revenues received using the technologies and may require minimum royalty amounts, milestone payments, or maintenance fees.
Mayo
In June 2009, the Company entered into a license agreement with the Mayo Foundation for Medical Education and Research (“Mayo”). The Company’s license agreement with Mayo was most recently amended and restated in September 2020. Under the license agreement, Mayo granted the Company an exclusive, worldwide license to certain Mayo patents and patent applications, as well as a non-exclusive, worldwide license with regard to certain Mayo know-how. The scope of the license covers any screening, surveillance or diagnostic test or tool for use in connection with any type of cancer, pre-cancer, disease or condition.
The licensed Mayo patents and patent applications contain both method and composition claims that relate to sample processing, analytical testing and data analysis associated with nucleic acid screening for cancers and other diseases. The jurisdictions covered by these patents and patent applications include the U.S., Australia, Canada, the European Union, China, Japan and Korea. Under the license agreement, the Company assumed the obligation and expense of prosecuting and maintaining the licensed Mayo patents and is obligated to make commercially reasonable efforts to bring to market products using the licensed Mayo intellectual property.
Pursuant to the Company’s agreement with Mayo, the Company is required to pay Mayo a low-single-digit royalty on the Company’s net sales of current and future products using the licensed Mayo intellectual property each year during the term of the Mayo agreement.
As part of the most recent amendment, the Company agreed to pay Mayo an additional $6.3 million, payable in five equal annual installments through 2024. The annual installments are recorded in research and development expenses in the Company’s condensed consolidated statements of operations.
The license agreement will remain in effect, unless earlier terminated by the parties in accordance with the agreement, until the last of the licensed patents expires in 2039 (or later, if certain licensed patent applications are issued). However, if the Company is still using the licensed Mayo know-how or certain Mayo-provided biological specimens or their derivatives on such expiration date, the term shall continue until the earlier of the date the Company stops using such know-how and materials and the date that is five years after the last licensed patent expires. The license agreement contains customary termination provisions and permits Mayo to terminate the license agreement if the Company sues Mayo or its affiliates, other than any such suit claiming an uncured material breach by Mayo of the license agreement.
In addition to granting the Company a license to the covered Mayo intellectual property, Mayo provides the Company with product development and research and development assistance pursuant to the license agreement and other collaborative arrangements. In September 2020, Mayo also agreed to make available certain personnel to provide such assistance through January 2025. In connection with this collaboration, the Company incurred charges of $1.5 million and $1.3 million for the three months ended September 30, 2022 and 2021, respectively. The Company incurred charges of $4.2 million and $3.5 million for the nine months ended September 30, 2022 and 2021, respectively. The charges incurred in connection with this collaboration are recorded in research and development expenses in the Company’s condensed consolidated statements of operations.
Johns Hopkins University (“JHU”)
Through the acquisition of Thrive, the Company acquired a worldwide exclusive license agreement with JHU for use of several JHU patents and licensed know-how. The license is designed to enable the Company to leverage JHU proprietary data in the development and commercialization of a blood-based, multi-cancer early detection test. The agreement terms include single-digit sales-based royalties and sales-based milestone payments of $10.0 million, $15.0 million, and $20.0 million upon achieving calendar year licensed product revenue using JHU proprietary data of $0.50 billion, $1.00 billion, and $1.50 billion, respectively.
v3.22.2.2
PFIZER PROMOTION AGREEMENT
 9 Months Ended
Sep. 30, 2022
PFIZER PROMOTION AGREEMENT  
PFIZER PROMOTION AGREEMENT PFIZER PROMOTION AGREEMENTIn August 2018, the Company entered into a Promotion Agreement (the “Original Promotion Agreement”) with Pfizer Inc. (“Pfizer”), which was amended and restated in October 2020 (the “Restated Promotion Agreement”). The Restated Promotion Agreement extended the relationship between the Company and Pfizer and restructured the manner in which the Company compensates Pfizer for promotion of the Cologuard test through a service fee, and provision of certain other sales and marketing services related to the Cologuard test. The Restated Promotion Agreement included fixed and performance-related
fees, some of which retroactively went into effect on April 1, 2020. In November 2021, the Company and Pfizer entered into an amendment to the Restated Promotion Agreement (the “November 2021 Amendment”), which provided that after November 30, 2021, Pfizer will no longer promote the Cologuard test to healthcare providers. The November 2021 Amendment provides that the Company will pay Pfizer a total of $35.9 million in three installments during the second, third, and fourth quarters of 2022. The November 2021 Amendment eliminated the Company's obligation to pay Pfizer royalties or other fees except for certain media fees, advertising fees, and any detail fees owed to Pfizer for promoting the Cologuard test prior to November 30, 2021. The $35.9 million fee incurred as a result of the November 2021 Amendment was recognized in full during the fourth quarter of 2021. All payments to Pfizer are recorded in sales and marketing expenses in the Company’s condensed consolidated statements of operations.
Under the Original Promotion Agreement, the service fee was calculated based on incremental gross profits over specified baselines during the term. Under the Restated Promotion Agreement (and prior to giving effect to the November 2021 Amendment), the service fee provided a fee-for-service model that included certain fixed fees and performance-related bonuses. The performance-related bonuses were contingent upon the achievement of certain annual performance criteria with any applicable expense being recognized ratably upon achievement of the payment becoming probable. The Company incurred charges of $2.5 million and $16.8 million for the service fee for the three months ended September 30, 2022 and 2021, respectively. The Company incurred charges of $7.5 million and $63.6 million for the service fee for the nine months ended September 30, 2022 and 2021, respectively. The Company incurred charges of $20.6 million and $30.2 million for promotion, sales and marketing services performed by Pfizer on behalf of the Company during the three months ended September 30, 2022 and 2021, respectively. The Company incurred charges of $86.1 million and $88.0 million for promotion, sales and marketing services performed by Pfizer on behalf of the Company during the nine months ended September 30, 2022 and 2021, respectively.
v3.22.2.2
STOCKHOLDERS' EQUITY
 9 Months Ended
Sep. 30, 2022
Equity [Abstract]  
STOCKHOLDERS' EQUITY STOCKHOLDERS’ EQUITY
OmicEra Acquisition Stock Issuance
In May 2022, the Company completed its acquisition of OmicEra. In connection with the acquisition, which is further described in Note 16, the Company issued 0.3 million shares of the Company's common stock that had a fair value of $14.8 million.
PreventionGenetics Acquisition Stock Issuance
In December 2021, the Company completed its acquisition of PreventionGenetics. In connection with the acquisition, which is further described in Note 16, the Company issued 1.1 million shares of the Company's common stock that had a fair value of $84.2 million.
Ashion Acquisition Stock Issuance
In April 2021, the Company completed its acquisition of Ashion. In connection with the acquisition, which is further described in Note 16, the Company issued 0.1 million shares of the Company’s common stock that had a fair value of $16.2 million.
Thrive Acquisition Stock Issuance
In January 2021, the Company completed its acquisition of Thrive. In connection with the acquisition, which is further described in Note 16, the Company issued 9.3 million shares of the Company’s common stock that had a fair value of $1.19 billion.
Targeted Digital Sequencing (“TARDIS”) License Acquisition Stock Issuance
In January 2021, the Company acquired a worldwide exclusive license to the TARDIS technology from The Translational Genomics Research Institute (“TGen”), which is further described in Note 16. As part of the consideration transferred, the Company issued 0.2 million shares of the Company’s common stock that had a fair value of $27.3 million.
Changes in Accumulated Other Comprehensive Income (Loss)
The amount recognized in AOCI for the nine months ended September 30, 2022 were as follows:
(In thousands)Foreign Currency Translation AdjustmentsUnrealized Gain (Loss) on Marketable Securities (1)Accumulated Other Comprehensive Income (Loss)
Balance at December 31, 2021$23 $(1,466)$(1,443)
Other comprehensive loss before reclassifications(3,176)(6,597)(9,773)
Amounts reclassified from accumulated other comprehensive loss— 146 146 
Net current period change in accumulated other comprehensive loss(3,176)(6,451)(9,627)
Balance at September 30, 2022$(3,153)$(7,917)$(11,070)
______________
(1)There was no tax impact from the amounts recognized in AOCI for the three and nine months ended September 30, 2022.
The amounts recognized in AOCI for the nine months ended September 30, 2021 were as follows:
(In thousands)Unrealized Gain (Loss) on Marketable SecuritiesAccumulated Other Comprehensive Income (Loss)
Balance at December 31, 2020$526 $526 
Other comprehensive loss before reclassifications(292)(292)
Amounts reclassified from accumulated other comprehensive income(271)(271)
Net current period change in accumulated other comprehensive income, before tax(563)(563)
Income tax benefit related to items of other comprehensive income170 170 
Balance at September 30, 2021$133 $133 
Amounts reclassified from AOCI for the nine months ended September 30, 2022 and 2021 were as follows:
Affected Line Item in the
Statements of Operations		Nine Months Ended September 30,
Details about AOCI Components (In thousands)20222021
Change in value of available-for-sale investments
Sales and maturities of available-for-sale investmentsInvestment income (loss), net$146 $(271)
Total reclassifications$146 $(271)
v3.22.2.2
STOCK-BASED COMPENSATION
 9 Months Ended
Sep. 30, 2022
Share-based Payment Arrangement [Abstract]  
STOCK-BASED COMPENSATION STOCK-BASED COMPENSATION
Stock-Based Compensation Plans
The Company maintains the following plans for which awards were granted from or had shares outstanding in 2022: 2010 Omnibus Long-Term Incentive Plan (As Amended and Restated Effective July 27, 2017), the 2019 Omnibus Long-Term Incentive Plan, and the 2010 Employee Stock Purchase Plan (collectively referred to as the “Stock Plans”).
Stock-Based Compensation Expense
The Company records stock-based compensation expense in connection with the amortization of restricted stock and restricted stock unit awards (“RSUs”), stock purchase rights granted under the Company’s employee stock purchase plan and stock options granted to employees, non-employee consultants and non-employee directors. The Company recorded $49.5 million and $63.6 million in stock-based compensation expense during the three months ended September 30, 2022 and 2021, respectively. The Company recorded $160.9 million and $283.3 million in stock-based compensation expense during the nine months ended September 30, 2022 and 2021, respectively.
As of September 30, 2022, there was approximately $416.1 million of expected total unrecognized compensation cost related to non-vested stock-based compensation arrangements granted under all equity compensation plans. The Company expects to recognize that cost over a weighted average period of 2.8 years.
In connection with the acquisition of Thrive, the Company accelerated the vesting of shares of previously unvested stock options and restricted stock units for employees with qualifying termination events. During the three months ended September 30, 2021, the Company accelerated 34,167 shares of previously unvested stock options and 24,865 shares of previously unvested restricted stock awards and restricted stock units and recorded $4.5 million of non-cash stock-based compensation for the accelerated awards. During the nine months ended September 30, 2021, the Company accelerated 138,163 shares of previously unvested stock options and 58,171 shares of previously unvested restricted stock awards and restricted stock units and recorded $19.0 million of non-cash stock-based compensation for the accelerated awards. As further discussed in Note 16, the Company also recorded $86.2 million in stock-based compensation related to accelerated vesting of awards held by Thrive employees in connection with the acquisition.
Stock Options
A summary of stock option activity under the Stock Plans is as follows:
OptionsSharesWeighted Average Exercise PriceWeighted Average Remaining Contractual Term (Years)Aggregate Intrinsic Value (1)
(Aggregate intrinsic value in thousands)
Outstanding, January 1, 20222,284,276 $34.65 5.5
Granted— — 
Exercised(643,922)9.30 
Forfeited(52,465)77.53 
Outstanding, September 30, 20221,587,889 $43.60 5.1$14,366 
Vested and expected to vest, September 30, 2022
1,587,889 $43.60 5.1$14,366 
Exercisable, September 30, 20221,401,945 $37.53 4.8$14,052 
______________
(1)The total intrinsic value of options exercised during the nine months ended September 30, 2022 and 2021 was $34.7 million and $148.8 million, respectively, determined as of the date of exercise.
The Company received approximately $6.0 million and $13.4 million from stock option exercises during the nine months ended September 30, 2022 and 2021, respectively.
Restricted Stock and Restricted Stock Units
The fair value of restricted stock and restricted stock units is determined on the date of grant using the closing stock price on that day.
A summary of restricted stock and restricted stock unit activity during the nine months ended September 30, 2022 is as follows:
Restricted stock and restricted stock unitsSharesWeighted Average Grant Date Fair Value (1)
Outstanding, January 1, 20224,320,910 $108.84 
Granted3,784,503 70.28 
Released (2)(1,629,309)95.46 
Forfeited(888,291)90.88 
Outstanding, September 30, 20225,587,813 $87.97 
______________
(1)The weighted average grant date fair value of the restricted stock units granted during the nine months ended September 30, 2021 was $133.80.
(2)The fair value of restricted stock units vested and converted to shares of the Company’s common stock was $155.5 million and $114.4 million during the nine months ended September 30, 2022 and 2021, respectively.
Performance Share Units
The Company has issued performance-based equity awards to certain employees which vest upon the achievement of certain performance goals, including financial performance targets and operational milestones.
In January 2022, the Company issued additional performance-based equity awards, which include a market condition in the form of a total shareholder return (“TSR”) modifier. At the end of the three-year performance period, the total units earned, if any, are adjusted by applying the modifier, ranging from 50% to 150%. The TSR modifier is based on stock price performance relative to a group of peer companies for the same three-year period. The fair value of the awards granted was calculated using a Monte Carlo simulation model, as the TSR modifier contains a market condition.
A summary of performance share unit activity is as follows:
Performance share unitsShares (1)Weighted Average Grant Date Fair Value (2)
Outstanding, January 1, 2022878,114 $107.18 
Granted805,782 89.43 
Released (3)(292,134)93.22 
Forfeited(373,372)91.91 
Outstanding, September 30, 20221,018,390 $102.74 
______________
(1)The performance share units listed above assumes attainment of maximum payout rates as set forth in the performance criteria. Applying actual or expected payout rates, the number of outstanding performance share units as of September 30, 2022 was 229,129.
(2)The weighted average grant date fair value of the performance share units granted during the nine months ended September 30, 2021 was $140.96.
(3)The fair value of performance share units vested and converted to shares of the Company’s common stock was $27.2 million for the nine months ended September 30, 2022. There were no performance share units vested and converted to shares of the Company’s common stock during the nine months ended September 30, 2021.
Employee Stock Purchase Plan (“ESPP”)
The fair value of ESPP shares is based on the assumptions in the following table:
Three Months Ended September 30,Nine Months Ended September 30,
2022202120222021
ESPP Shares
Risk-free interest rates
(1)
(1)
1.49% - 2.73%
0.04% - 0.16%
Expected term (in years)
(1)
(1)
0.5 - 2
0.5 - 2
Expected volatility
(1)
(1)
50.94% - 60.34%
48.38% - 68.51%
Dividend yield(1)(1)—%—%
______________
(1)The Company did not issue stock purchase rights under its 2010 Employee Stock Purchase Plan during the period indicated.
v3.22.2.2
COMMITMENTS AND CONTINGENCIES
 9 Months Ended
Sep. 30, 2022
Commitments and Contingencies Disclosure [Abstract]  
COMMITMENTS AND CONTINGENCIES COMMITMENTS AND CONTINGENCIES
Leases
Supplemental disclosure of cash flow information related to the Company’s cash and non-cash activities with its leases are as follows:
Nine Months Ended September 30,
(In thousands)20222021
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases$24,579$19,835
Operating cash flows from finance leases520723
Finance cash flows from finance leases3,5883,805
Non-cash investing and financing activities:
Right-of-use assets obtained in exchange for new operating lease liabilities (1)$25,471$60,480
Right-of-use assets obtained in exchange for new finance lease liabilities8,2034,296
Weighted-average remaining lease term - operating leases (in years)7.608.14
Weighted-average remaining lease term - finance leases (in years)3.503.13
Weighted-average discount rate - operating leases6.34 %6.28 %
Weighted-average discount rate - finance leases6.51 %5.42 %
_____________
(1)For the nine months ended September 30, 2022, this includes right-of-use assets recorded as a result of the lease modification discussed below of $8.1 million. For the nine months ended September 30, 2021, this includes right-of-use assets acquired as part of the business combinations described in Note 16 of $39.6 million.
As of September 30, 2022 and December 31, 2021, the Company’s right-of-use assets from operating leases are $175.9 million and $174.2 million, respectively, which are reported in operating lease right-of-use assets in the Company’s condensed consolidated balance sheets. As of September 30, 2022, the Company has outstanding operating lease obligations of $211.7 million, of which $27.1 million is reported in operating lease liabilities, current portion and $184.6 million is reported in operating lease liabilities, less current portion in the Company’s condensed consolidated balance sheets. As of December 31, 2021, the Company had outstanding operating lease obligations of $201.9 million, of which $19.7 million is reported in operating lease liabilities, current portion and $182.2 million is reported in operating lease liabilities, less current portion in the Company’s condensed consolidated balance sheets.
As of September 30, 2022 and December 31, 2021, the Company’s right-of-use assets from finance leases are $10.8 million and $18.2 million, respectively, which are reported in other long-term assets, net in the Company’s condensed consolidated balance sheets. As of September 30, 2022, the Company has outstanding finance lease obligations of $11.1 million, of which $3.1 million is reported in other current liabilities and $8.0 million is reported in other long-term liabilities in the Company’s condensed consolidated balance sheets. As of December 31, 2021, the Company had outstanding finance lease obligations of $18.7 million, of which $6.2 million is reported in other current liabilities and $12.5 million is reported in other long-term liabilities in the Company’s condensed consolidated balance sheets.
On June 1, 2022, certain of the Company’s vehicle leases were amended. The Company determined that this amendment was a lease modification, effective June 1, 2022. Under the lease modification guidance within ASC 842, the Company reassessed the lease classification and remeasured the corresponding right-of-use assets and lease liabilities. The Company determined that a portion of the modified leases are to be accounted for as operating leases, and therefore derecognized the previous finance lease right-of-use asset of $10.3 million and the related finance lease liability of $10.8 million, and recognized an operating lease right-of-use asset of $8.1 million and the related operating lease liability of $8.6 million.
Legal Matters
The Company records reserves and accrues costs for certain legal proceedings and regulatory matters to the extent that it determines an unfavorable outcome is probable and the amount of the loss can be reasonably estimated. While such reserves and accrued costs reflect the Company’s best estimate of the probable loss for such matters, the recorded amounts may differ materially from the actual amount of any such losses. In some cases, no estimate of the possible loss or range of loss in excess of amounts accrued, if any, can be made because of the inherently unpredictable nature of legal and regulatory proceedings, which may be exacerbated by various factors, including but not limited to, they may involve indeterminate claims for monetary damages or may involve fines, penalties or punitive damages; present novel legal theories or legal uncertainties; involve disputed facts; represent a shift in regulatory policy; involve a large number of parties, claimants or regulatory bodies; are in the early stages of the proceedings; involve a number of separate proceedings and/or a wide range of potential outcomes; or result in a change of business practices.
As of the date of this Quarterly Report on Form 10-Q, amounts accrued for legal proceedings and regulatory matters were not material except for the amounts accrued related to the Medicare Date of Service Rule Investigation (the “DOS Rule Investigation”) discussed below. However, it is possible that in a particular quarter or annual period the Company’s financial condition, results of operations, cash flow and/or liquidity could be materially adversely affected by an ultimate unfavorable resolution of, or development in, legal and/or regulatory proceedings, including as described below. Except for the proceedings discussed below, the Company believes that the ultimate outcome of any of the regulatory and legal proceedings that are currently pending against it should not have a material adverse effect on financial condition, results of operations, cash flow or liquidity.
The Company is currently responding to civil investigative demands and administrative subpoenas issued pursuant to the Health Insurance Portability and Accountability Act of 1996 by the United States Department of Justice (“DOJ”) concerning Genomic Health’s compliance with the Medicare Date of Service billing regulations. The Company has been cooperating with these inquiries and has produced documents in response thereto.
During the second quarter of 2021, as part of ongoing discussions between the DOJ and the Company regarding the DOS Rule Investigation, the DOJ presented an initial estimate of civil damages in the amount of $48.2 million relating to alleged non-compliance with the Medicare Date of Service billing regulations from 2007 to 2020. The initial civil damages estimate did not include potential treble damages, civil or criminal penalties or other remedies that the DOJ could seek against the Company. The DOJ has since presented a total adjusted demand of $53.8 million for civil damages, which includes a multiplier and penalties. Based on the Company’s review and analysis of the DOJ presentation, ongoing discussions held with the DOJ, the civil damages estimate, and range of potential exposure, the Company recorded an accrual of approximately $10 million as of September 30, 2022.
As noted above, litigation outcomes are difficult to predict, and the estimation of probable losses requires an analysis of multiple possible outcomes that often depend on judgments about potential actions by third parties. Accordingly, the recorded accrual of approximately $10 million as of September 30, 2022 is based on several factors, considerations, and judgments, and the ultimate resolution of this matter could result in a material loss in excess of the recorded accrual.
On June 24, 2019, Niles Rosen M.D. filed a sealed ex parte qui tam lawsuit against the Company in the United States District Court for the Middle District of Florida, that alleged a violation of the Federal Anti-Kickback Statute and False Claims Act for offering gift cards to patients in exchange for returning the Cologuard screening test (the “Qui Tam Suit”). Dr. Rosen seeks on behalf of the U.S. government and himself an award of civil penalties, treble damages and fees and costs. On February 25, 2020, the Company received a civil investigative demand by the DOJ related to the Company’s gift card program. The Company produced documents in response thereto. On March 25, 2021, the DOJ filed a notice of its election to decline intervention in the Qui Tam Suit. This election does not prevent Dr. Rosen from continuing the Qui Tam Suit. On April 12, 2021, Dr. Rosen filed an amended complaint against the Company, alleging violations of the Federal Anti-Kickback Statute and False Claims Act. The Company first learned of the Qui Tam Suit and the DOJ’s election to decline intervention in July 2021. The Company intends to vigorously defend itself against Dr. Rosen's claims and seek, among other things, the Company’s attorneys' fees and costs incurred in defending this action. Although the Company denies Dr. Rosen's allegations and believes that it has meritorious defenses to his False Claims Act claims, neither the outcome of the litigation nor can a reasonable estimate or an estimated range of loss associated with the litigation be determined at this time.
Adverse outcomes from the DOS Rule Investigation and the Qui Tam Suit could include the Company being required to pay treble damages, incur civil and criminal penalties, paying attorneys’ fees, entering into a corporate integrity agreement, being excluded from participation in government healthcare programs, including Medicare and Medicaid, and other adverse actions that could materially affect the Company’s business, financial condition, and results of operation.
v3.22.2.2
WISCONSIN ECONOMIC DEVELOPMENT TAX CREDITS
 9 Months Ended
Sep. 30, 2022
WISCONSIN ECONOMIC DEVELOPMENT TAX CREDITS [Abstract]  
WISCONSIN ECONOMIC DEVELOPMENT TAX CREDITS WISCONSIN ECONOMIC DEVELOPMENT TAX CREDITS
During February 2015, the Company entered into an agreement with the Wisconsin Economic Development Corporation (“WEDC,” “Original WEDC Agreement”) to earn $9.0 million in refundable tax credits on the condition that the Company expends $26.3 million in capital investments and establishes and maintains 758 full-time positions over a seven-year period.
During December 2021, the Company amended its agreement with the WEDC (“Amended WEDC Agreement”) to earn an additional $18.5 million in refundable tax credits on the condition that the Company expends $350.0 million in capital investments and establishes and maintains 1,300 additional full-time positions over a five-year period. The capital investment credits are earned at a rate of 10% of eligible capital investments up to a maximum of $7.0 million, while the jobs creation credits are earned annually pursuant to the agreement.
The tax credits earned are first applied against the tax liability otherwise due, and if there is no such liability present, the claim for tax credits will be reimbursed in cash to the Company. The maximum amount of the refundable tax credit to be earned for each year is fixed, and the Company earns the credits by meeting certain capital investment and job creation thresholds over the term of the agreement. Should the Company earn and receive the job creation tax credits but not maintain those full-time positions through the end of the agreement, the Company may be required to pay those credits back to the WEDC.
Under the Original WEDC Agreement, the Company recorded the earned tax credits as job creation and capital investments occurred. The tax credits earned from capital investment are being recognized as an offset to depreciation expense over the expected life of the acquired capital assets. The tax credits earned related to job creation were recognized as an offset to operational expenses through December 31, 2020.
As of September 30, 2022, the Company has earned all $9.0 million of the refundable tax credits and has received payment of $9.0 million from the WEDC under the Original WEDC Agreement.
Under the Amended WEDC Agreement, the Company records the earned tax credits as job creation and capital investments occurs. The tax credits earned from capital investment are recognized as a reduction to capital expenditures at the time the costs are incurred, and then as an offset to depreciation expense over the expected life of the acquired capital assets. The tax credits earned related to job creation are recognized as an offset to operational expenses in the period in which the credits are earned. The credits recognized will be required to be repaid if the Company does not maintain minimum cumulative job requirements.
As of September 30, 2022, the Company has earned $9.0 million of the refundable tax credits under the Amended WEDC Agreement. The unpaid portion is $9.0 million as of September 30, 2022, of which $1.7 million is reported in prepaid expenses and other current assets and $7.3 million is reported in other long-term assets, net in the Company’s condensed consolidated balance sheets reflecting when collection of the refundable tax credits is expected to occur.
During the three and nine months ended September 30, 2022, the Company recorded zero and $1.0 million respectively, as a reduction to operational expenses for the credits earned for job creation.
v3.22.2.2
ACQUISITIONS AND DIVESTITURES
 9 Months Ended
Sep. 30, 2022
Business Combination and Asset Acquisition [Abstract]  
ACQUISITIONS AND DIVESTITURES ACQUISITIONS AND DIVESTITURES
Business Combinations
OmicEra Diagnostics, GmbH
On May 2, 2022, the Company completed the acquisition (the “OmicEra Acquisition”) of all of the outstanding equity interests of OmicEra Diagnostics GmbH. The OmicEra Acquisition provided the Company a state-of-the-art proteomics lab based in Planegg, Germany. OmicEra combines its mass spectrometry-based proteome analysis technology with its in-house proteomics scientific expertise to discover more reliable and valuable protein biomarkers, which will expand the Company’s research and development capabilities. The Company has included the financial results of OmicEra in the consolidated financial statements from the date of the combination.
The combination date fair value of the consideration transferred for OmicEra was approximately $19.4 million, which consisted of the following:
(In thousands)
Common stock issued$14,792 
Contingent consideration4,600 
Working capital adjustment to be settled in cash16 
Total purchase price$19,408 
The fair value of the 265,186 common shares issued as part of the consideration transferred was determined on the basis of the average of the high and low market price of the Company’s shares on the acquisition date, which was $55.78.
The purchase agreement requires the Company to pay a maximum of $6.0 million of additional cash consideration to OmicEra upon the achievement of certain earnout conditions related to the identification of protein biomarkers, as well as the growth of the proteomics research and development team. The fair value of the contingent consideration at the acquisition date was $4.6 million. The fair value of the contingent consideration was estimated using a probability-weighted scenario-based discounted cash flow model. This fair value measurement is based on significant inputs not observable in the market and thus represents a Level 3 measurement as defined in ASC 820. The key assumptions are described in Note 7.
The purchase price was allocated to the underlying assets acquired and liabilities assumed based upon their estimated fair values including immaterial measurement period adjustments as follows:
(In thousands)
Net operating assets$2,586 
Developed technology10,000 
Total identifiable assets acquired12,586 
Net operating liabilities(3,987)
Net identifiable assets acquired8,599 
Goodwill10,809 
Net assets acquired$19,408 
The Company recorded $10.0 million of identifiable intangible assets related to the developed technology associated with OmicEra’s proteome analysis platform. Developed technology represents purchased technology that had reached technological feasibility and for which OmicEra had substantially completed development as of the date of combination. The fair value of the developed technology has been determined using the income approach multi-period excess earnings method, which involves significant unobservable inputs (Level 3 inputs). These inputs include projected sales, margin, obsolescence factor, required rate of return, and tax rate. Cash flows were discounted to their present value as of the closing date. Developed technology is amortized on a straight-line basis over its estimated useful life of 16 years.
The calculation of the excess purchase price over the estimated fair value of the tangible net assets and intangible assets acquired was recorded to goodwill, which is primarily attributed to the acquired workforce expertise, the potential to enhance the capabilities of current and future products, and expected research and development synergies. The total goodwill related to this combination is not deductible for tax purposes.
The total purchase price allocation is preliminary and based upon estimates and assumptions that are subject to change within the measurement period as additional information for the estimates is obtained. The measurement period remains open pending the completion of valuation procedures related to certain acquired assets and liabilities assumed, primarily in connection with the developed technology intangible asset.
Pro forma impact and results of operations disclosures have not been included due to immateriality.
Acquisition-related costs were not material and have been recorded within general and administrative expenses in the condensed consolidated statement of operations. These costs include fees associated with financial, legal, accounting, and other advisors incurred to complete the merger.
PreventionGenetics LLC
On December 31, 2021, the Company completed the acquisition (the “PreventionGenetics Acquisition”) of all of the outstanding equity interests of PreventionGenetics, LLC. The PreventionGenetics Acquisition provided the Company a Clinical Laboratory Improvement Amendments (“CLIA”) certified and College of American Pathologist (“CAP”) accredited sequencing lab based in Marshfield, Wisconsin. PreventionGenetics provides more than 5,000 predefined genetic tests for nearly all clinically relevant genes, additional custom panels, and comprehensive germline, whole exome (“PGxome®”), and whole genome (“PGnome®”) sequencing tests.
Refer to the Company’s 2021 Form 10-K for detailed disclosures on the combination, including the fair value of the consideration transferred, purchase price allocation, and goodwill and intangible assets identified in the transaction. During the three and nine months ended September 30, 2022, there were no material changes to the purchase price and purchase price allocation. The measurement period remains open pending the completion of valuation procedures related to certain acquired assets and liabilities assumed, primarily in connection with the intangible assets.
Ashion Analytics, LLC
On April 14, 2021, the Company completed the acquisition (“Ashion Acquisition”) of all of the outstanding equity interests of Ashion Analytics, LLC from PMed Management, LLC (“PMed”), which is a subsidiary of TGen. The Ashion Acquisition provided the Company a CLIA certified and CAP accredited sequencing lab based in Phoenix, Arizona. Ashion developed the GEM ExTra® test, a comprehensive genomic cancer test, and provides access to whole exome, matched germline, and transcriptome sequencing capabilities.
Refer to the Company’s 2021 Form 10-K for detailed disclosures on the combination, including the fair value of the consideration transferred, purchase price allocation, and goodwill and intangible assets identified in the transaction. During the three and nine months ended September 30, 2022, there were no changes to the purchase price allocation and the measurement period has closed.
Thrive Earlier Detection Corporation
On January 5, 2021, the Company completed the acquisition of all of the outstanding capital stock of Thrive Earlier Detection Corporation. Thrive, headquartered in Cambridge, Massachusetts, is a healthcare company dedicated to incorporating earlier cancer detection into routine medical care. The Company expects that combining Thrive's early-stage multi-cancer early detection test with the Company’s scientific platform, clinical organization and commercial infrastructure will bring an accurate blood-based, multi-cancer detection test to patients faster.
Refer to the Company’s 2021 Form 10-K for detailed disclosures on the combination, including the fair value of the consideration transferred, final purchase price allocation, and goodwill and intangible assets identified in the transaction.
Asset Acquisitions
PFS Genomics Inc.
On May 3, 2021, the Company acquired 90% of the outstanding capital stock of PFS Genomics Inc. (“PFS”). On June 23, 2021, the Company completed the acquisition of the remaining 10% interest in PFS. The Company expects this acquisition to expand its ability to help guide early-stage breast cancer treatment through individualized radiotherapy treatment decisions.
The transaction was treated as an asset acquisition under GAAP because substantially all of the fair value of the gross assets acquired were deemed to be associated with the acquired technology. Refer to the Company’s 2021 Form 10-K for detailed disclosures on the asset acquisition, including the fair value of the consideration transferred and purchase price allocation.
TARDIS License Agreement
On January 11, 2021, the Company entered into a worldwide exclusive license to the proprietary TARDIS technology from TGen, an affiliate of City of Hope. Under the agreement, the Company acquired a royalty-free, worldwide exclusive license to proprietary TARDIS patents and know-how. The Company intends to develop and commercialize the TARDIS technology as a minimal residual disease test.
The Company accounted for this transaction as an asset acquisition. Refer to the Company’s 2021 Form 10-K for detailed disclosures on the asset acquisition, including the fair value of the consideration transferred and information related to contingent milestones.
Divestitures
Oncotype DX Genomic Prostate Score Test
On August 2, 2022, pursuant to an asset purchase agreement with MDxHealth SA, the Company completed the sale of the intellectual property and know-how related to the Company’s Oncotype DX Genomic Prostate Score test, which will allow the Company to focus on the highest impact projects core to the Company’s vision.
The closing date fair value of the consideration received for the asset was approximately $29.6 million, which consisted of the following:
(In thousands)
Cash$25,000 
MDxHealth American Depository Shares 4,631 
Contingent consideration— 
Total consideration$29,631 
The fair value of the 691,171 American Depository Shares received as part of the consideration transferred was determined on the basis of the average of the high and low market price of the MDxHealth’s shares on the date of divestiture, which was $6.70.
The asset purchase agreement requires MDxHealth to pay the Company up to an additional $70.0 million of contingent consideration that would be earned and receivable in cash and/or equity based on the achievement of certain revenue milestones by MDxHealth between 2023 and 2025. The contingent consideration will be recognized as other operating income in the condensed consolidated statement of operations when it is probable a significant reversal of a gain would not occur.
The carrying value of the asset sold, which was previously included in intangible assets, net on the condensed consolidated balance sheet, was $42.9 million as of the closing date. As a result of the sale, the Company recorded a loss of $13.2 million, which is included in other operating loss in the condensed consolidated statement of operations for the three and nine months ended September 30, 2022.
Further, the Company agreed to provide certain transitional services to MDxHealth through December 31, 2022 and lab testing services for a period of up to 24 months.
Transaction-related costs were not material and have been recorded within general and administrative expenses in the condensed consolidated statement of operations. These costs include fees associated with financial, legal, accounting, and other advisors incurred to complete the divestiture.
v3.22.2.2
SEGMENT INFORMATION
 9 Months Ended
Sep. 30, 2022
Segment Reporting [Abstract]  
SEGMENT INFORMATION SEGMENT INFORMATION
Management determined that the Company functions as a single operating segment, and thus reports as a single reportable segment. This operating segment is focused on the development and global commercialization of clinical laboratory services allowing healthcare providers and patients to make individualized treatment decisions. Management assessed the discrete financial information routinely reviewed by the Company's Chief Operating Decision Maker, its President and Chief Executive Officer, to monitor the Company's operating performance and support decisions regarding allocation of resources to its operations. Performance is continuously monitored at the consolidated level to timely identify deviations from expected results.
The following table summarizes total revenue from customers by geographic region. Product revenues are attributed to countries based on ship-to location.
Three Months Ended September 30,Nine Months Ended September 30,
(In thousands)2022202120222021
United States$491,540 $429,150 $1,441,748 $1,213,142 
Outside of United States31,533 27,229 89,536 80,133 
Total revenues$523,073 $456,379 $1,531,284 $1,293,275 
Long-lived assets located in countries outside of the United States are not significant.
v3.22.2.2
INCOME TAXES
 9 Months Ended
Sep. 30, 2022
Income Tax Disclosure [Abstract]  
INCOME TAXES INCOME TAXESThe Company recorded an income tax benefit of $3.1 million and $3.9 million for the three months ended September 30, 2022 and 2021, respectively. The Company recorded an income tax benefit of $6.9 million and $242.6 million for the nine months ended September 30, 2022 and 2021, respectively. The Company’s income tax benefit recorded during the three months ended September 30, 2022 is primarily related to the future limitations on and expiration of certain Federal and State deferred tax assets, offset by current foreign and state tax expense. The Company’s income tax benefit recorded during the nine months ended September 30, 2022 is primarily related to the future limitations on and expiration of certain Federal and State deferred tax assets, offset by current foreign and state tax expense. A deferred tax liability of approximately $22.9 million was recorded as of September 30, 2022, which is included in other long-term liabilities on the Company’s condensed consolidated balance sheet. The Company continues to maintain a full valuation allowance against its deferred tax assets based on management’s determination that it is more likely than not the benefit will not be realized.
The Company had $26.0 million and $21.8 million of unrecognized tax benefits at September 30, 2022 and December 31, 2021, respectively. These amounts have been recorded as a reduction to the Company’s deferred tax asset, if recognized they would not have an impact on the effective tax rate due to the existing valuation allowance. Certain of the Company's unrecognized tax benefits could change due to activities of various tax authorities, including possible settlement of audits, or through normal expiration of various statutes of limitations. The Company does not expect a material change in unrecognized tax benefits in the next twelve months.
As of September 30, 2022, due to the carryforward of unutilized net operating losses and research and development credits, the Company is subject to U.S. federal income tax examinations for the tax years 2002 through 2022, and to state income tax examinations for the tax years 2002 through 2022. No interest or penalties related to income taxes have been accrued or recognized as of September 30, 2022.
v3.22.2.2
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Policies)
 9 Months Ended
Sep. 30, 2022
Accounting Policies [Abstract]  
Basis of Presentation and Principles of Consolidation Basis of Presentation and Principles of ConsolidationThe accompanying condensed consolidated financial statements, which include the accounts of Exact Sciences Corporation and those of its wholly owned subsidiaries and variable interest entities, are unaudited and have been prepared on a basis substantially consistent with the Company’s audited financial statements and notes as of and for the year ended December 31, 2021 included in the Company’s Annual Report on Form 10-K (the “2021 Form 10-K”). All intercompany transactions and balances have been eliminated upon consolidation. These condensed consolidated financial statements are prepared in conformity with accounting principles generally accepted in the United States of America (“GAAP”) and follow the requirements of the Securities and Exchange Commission (“SEC”) for interim reporting. In the opinion of management, the accompanying unaudited condensed consolidated financial statements contain all adjustments (consisting only of adjustments of a normal and recurring nature) considered necessary for a fair statement of its financial position, operating results and cash flows for the periods presented. The condensed consolidated balance sheet at December 31, 2021 has been derived from audited financial statements, but does not contain all of the footnote disclosures from the 2021 Form 10-K. The results of the Company’s operations for any interim period are not necessarily indicative of the results of the Company’s operations for any other interim period or for a full fiscal year. The statements should be read in conjunction with the audited financial statements and related notes included in the 2021 Form 10-K.
Use of Estimates
Use of Estimates
The preparation of the condensed consolidated 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. Critical accounting policies are those that affect the Company’s financial statements materially and involve difficult, subjective or complex judgments by management, and actual results could differ from those estimates. These estimates include revenue recognition, valuation of intangible assets and goodwill, and accounting for income taxes among others. The Company’s critical accounting policies and estimates are explained further in the notes to the condensed consolidated financial statements in this Quarterly Report and the 2021 Form 10-K.
The spread of the coronavirus (“COVID-19”) has affected many segments of the global economy, including the cancer screening and diagnostics industry. The Company assessed certain accounting matters that generally require consideration of forecasted financial information in context with the information reasonably available to the Company and the unknown future impacts of COVID-19 as of September 30, 2022 and through the date of the filing of this Quarterly Report on Form 10-Q. The accounting matters assessed included, but were not limited to, the Company’s allowance for doubtful accounts and credit losses, marketable and non-marketable investments, software, and the carrying value of the goodwill and other long-lived assets. The Company’s future assessment of the magnitude and duration of COVID-19, as well as other factors, could result in additional material impacts to the Company’s consolidated financial statements in future reporting periods.
The pandemic and related precautionary measures began to materially disrupt the Company's operations in March 2020 and may continue to disrupt the business for an unknown period of time. As a result, the pandemic had an impact on the Company’s revenues and operating results.
The ultimate impact of COVID-19 depends on factors beyond the Company’s knowledge or control, including the duration and severity of the outbreak, as well as third-party actions taken to contain its spread and mitigate its public health effects. As a result, the Company is unable to estimate the extent to which COVID-19 will negatively impact its financial results or liquidity.
Collateralized Debt Instruments
Collateralized Debt Instruments
Debt instruments that are collateralized by security interests in financial assets held by the Company are accounted for as a secured borrowing and therefore: (i) the asset balances pledged as collateral are included within the applicable balance sheet line item and the borrowings are included within long-term debt in the condensed consolidated balance sheet; (ii) interest expense is included within the condensed consolidated statements of operations; and (iii) in the case of collateralized accounts receivable, receipts from customers related to the underlying accounts receivable are reflected as operating cash flows, and (iv) borrowings and repayments under the collateralized loans are reflected as financing cash flows within the condensed consolidated statements of cash flows.
Reclassifications
Reclassifications
Certain prior year amounts have been reclassified to conform to the current year presentation in the condensed consolidated financial statements and accompanying notes to the condensed consolidated financial statements.
Recent Accounting Pronouncements
Recent Accounting Pronouncements
Recently Adopted Accounting Pronouncements
In October 2021, The Financial Accounting Standards Board (“FASB”) issued Accounting Standards Update (“ASU”) No. 2021-08, Business Combinations (Topic 805). This update requires that an entity (acquirer) recognize and measure contract assets and contract liabilities acquired in a business combination in accordance with Accounting Standards Codification (“ASC”) 606. This differs from the current requirement to measure contract assets and contract liabilities acquired in a business combination at fair value. The amendments in this update should be applied prospectively, and are effective for fiscal years beginning after December 15, 2022, including interim periods within those fiscal years. Early adoption is permitted, including adoption in an interim period. The Company early adopted the amendments in this update during the first quarter of fiscal year 2022. There was no material impact to the Company’s condensed consolidated financial statements.
In June 2022, the FASB issued ASU No. 2022-03, Fair Value Measurement (Topic 820) – Fair Value Measurement of Equity Securities Subject to Contractual Sale Restrictions. This update clarifies that a contractual restriction on the sale of an equity security is not part of the unit of account of the security and should not be considered in measuring fair value. The update also provides that an entity cannot recognize and measure a contractual sale restriction as a separate unit of account. The amendments in this update should be applied prospectively, and are effective for fiscal years beginning after December 15, 2023, including interim periods within those fiscal years. Early adoption is permitted, including adoption in an interim period. The Company early adopted the amendments in this update during the third quarter of fiscal year 2022. There was no material impact to the Company’s condensed consolidated financial statements.
Net Loss Per Share
Net Loss Per Share
Basic net loss per common share was determined by dividing net loss applicable to common stockholders by the weighted average common shares outstanding during the period. Basic and diluted net loss per share is the same because all outstanding common stock equivalents have been excluded, as they are anti-dilutive as a result of the Company’s losses.
v3.22.2.2
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES (Tables)
 9 Months Ended
Sep. 30, 2022
Accounting Policies [Abstract]  
Schedule of potentially issuable common shares not included in the computation of diluted net loss per share because they would have an anti-dilutive effect
The following potentially issuable common shares were not included in the computation of diluted net loss per share because they would have an anti-dilutive effect due to net losses for each period:
September 30,
(In thousands)20222021
Shares issuable in connection with acquisitions45 45 
Shares issuable upon exercise of stock options1,588 2,380 
Shares issuable upon the release of restricted stock awards5,588 4,306 
Shares issuable upon the release of performance share units1,018 863 
Shares issuable upon conversion of convertible notes20,309 20,309 
28,548 27,903 
v3.22.2.2
REVENUE (Tables)
 9 Months Ended
Sep. 30, 2022
Revenue from Contract with Customer [Abstract]  
Schedule of disaggregation of revenue
The following table presents the Company’s revenues disaggregated by revenue source:
Three Months Ended September 30,Nine Months Ended September 30,
(In thousands)2022202120222021
Screening
Medicare Parts B & C$140,366 $116,088 $389,373 $329,034 
Commercial188,923 151,245 531,789 419,268 
Other31,470 13,045 100,013 36,341 
Total Screening360,759 280,378 1,021,175 784,643 
Precision Oncology
Medicare Parts B & C$47,038 $51,607 $152,224 $144,753 
Commercial42,660 42,844 134,658 136,800 
International31,533 27,229 89,536 80,133 
Other30,212 23,732 81,640 50,942 
Total Precision Oncology151,443 145,412 458,058 412,628 
COVID-19 Testing$10,871 $30,589 $52,051 $96,004 
Total$523,073 $456,379 $1,531,284 $1,293,275 
v3.22.2.2
MARKETABLE SECURITIES (Tables)
 9 Months Ended
Sep. 30, 2022
Cash and Cash Equivalents [Abstract]  
Schedule of restricted cash and cash equivalents
The following table sets forth the Company’s cash, cash equivalents, and marketable securities at September 30, 2022 and December 31, 2021:
(In thousands)September 30, 2022December 31, 2021
Cash and cash equivalents
Cash and money market$173,968 $247,335 
Cash equivalents61,338 68,136 
Total cash and cash equivalents235,306 315,471 
Marketable securities
Available-for-sale debt securities$428,421 $711,669 
Equity securities5,387 3,336 
Total marketable securities433,808 715,005 
Total cash, cash equivalents and marketable securities$669,114 $1,030,476 
Cash, Cash Equivalents and Investments
The following table sets forth the Company’s cash, cash equivalents, and marketable securities at September 30, 2022 and December 31, 2021:
(In thousands)September 30, 2022December 31, 2021
Cash and cash equivalents
Cash and money market$173,968 $247,335 
Cash equivalents61,338 68,136 
Total cash and cash equivalents235,306 315,471 
Marketable securities
Available-for-sale debt securities$428,421 $711,669 
Equity securities5,387 3,336 
Total marketable securities433,808 715,005 
Total cash, cash equivalents and marketable securities$669,114 $1,030,476 
Schedule of available-for-sale securities
Available-for-sale debt securities, including the classification within the condensed consolidated balance sheet at September 30, 2022, consisted of the following:
(In thousands)Amortized CostGains in Accumulated Other Comprehensive Income (Loss) (1)Losses in Accumulated Other Comprehensive Income (Loss) (1)Estimated Fair Value
Cash equivalents
Commercial paper$58,917 $— $— $58,917 
U.S. government agency securities2,421 — — 2,421 
Total cash equivalents61,338 — — 61,338 
Marketable securities
Corporate bonds$116,627 $— $(2,423)$114,204 
U.S. government agency securities248,351 — (4,496)243,855 
Certificates of deposit5,500 — — 5,500 
Commercial paper1,988 — — 1,988 
Asset backed securities63,872 — (998)62,874 
Total marketable securities436,338 — (7,917)428,421 
Total available-for-sale securities$497,676 $— $(7,917)$489,759 
______________
(1)Gains and losses in accumulated other comprehensive income (loss) (“AOCI”) are reported before tax impact.
Available-for-sale debt securities, including the classification within the condensed consolidated balance sheet at December 31, 2021, consisted of the following:
(In thousands)Amortized CostGains in Accumulated Other Comprehensive Income (Loss) (1) Losses in Accumulated Other Comprehensive Income (Loss) (1)Estimated Fair Value
Cash equivalents
U.S. government agency securities$3,543 $— $— $3,543 
Commercial paper64,593 — — 64,593 
Total cash equivalents68,136 — — 68,136 
Marketable securities
U.S. government agency securities$250,793 $— $(873)$249,920 
Asset backed securities94,565 2 (107)94,460 
Commercial paper6,996 — — 6,996 
Certificates of deposit47,147 2 (10)47,139 
Corporate bonds313,634 13 (493)313,154 
Total marketable securities713,135 17 (1,483)711,669 
Total available-for-sale securities$781,271 $17 $(1,483)$779,805 
______________
(1)Gains and losses in AOCI are reported before tax impact.
Schedule of contractual maturities of available-for-sale investments
The following table summarizes contractual underlying maturities of the Company’s available-for-sale debt securities at September 30, 2022:
Due one year or lessDue after one year through five years
(In thousands)CostFair ValueCostFair Value
Cash equivalents
Commercial paper$58,917 $58,917 $— $— 
U.S. government agency securities2,421 2,421 — — 
Total cash equivalents61,338 61,338 — — 
Marketable securities
U.S. government agency securities$238,617 $234,274 $9,734 $9,581 
Corporate bonds93,666 92,032 22,961 22,172 
Certificates of deposit5,500 5,500 — — 
Asset backed securities— — 63,872 62,874 
Commercial paper1,988 1,988 — — 
Total marketable securities339,771 333,794 96,567 94,627 
Total available-for-sale securities$401,109 $395,132 $96,567 $94,627 
Schedule of gross unrealized losses and fair values of investments in an unrealized loss position
The following table summarizes the gross unrealized losses and fair values of available-for-sale debt securities in an unrealized loss position as of September 30, 2022, aggregated by investment category and length of time those individual securities have been in a continuous unrealized loss position:
Less than one yearOne year or greaterTotal
(In thousands)Fair ValueGross Unrealized LossFair ValueGross Unrealized LossFair ValueGross Unrealized Loss
Marketable securities
Corporate bonds$114,204 $(2,423)$— $— $114,204 $(2,423)
Asset backed securities61,924 (998)— — 61,924 (998)
U.S. government agency securities243,855 (4,496)— — 243,855 (4,496)
Total available-for-sale securities$419,983 $(7,917)$— $— $419,983 $(7,917)
v3.22.2.2
INVENTORY (Tables)
 9 Months Ended
Sep. 30, 2022
Inventory Disclosure [Abstract]  
Schedule of inventory
Inventory consisted of the following:
(In thousands)September 30, 2022December 31, 2021
Raw materials$56,829 $51,321 
Semi-finished and finished goods57,870 53,673 
Total inventory$114,699 $104,994 
v3.22.2.2
PROPERTY, PLANT AND EQUIPMENT (Tables)
 9 Months Ended
Sep. 30, 2022
Property, Plant and Equipment [Abstract]  
Schedule of property, plant and equipment, net
The carrying value and estimated useful lives of property, plant and equipment are as follows:
(In thousands)Estimated Useful LifeSeptember 30, 2022December 31, 2021
Property, plant and equipment
Landn/a$4,716 $4,716 
Leasehold and building improvements(1)179,025 147,083 
Land improvements15 years6,415 5,206 
Buildings
30 - 40 years
271,858 210,560 
Computer equipment and computer software3 years132,416 109,119 
Laboratory equipment
3 - 10 years
232,189 189,748 
Furniture and fixtures
3 - 10 years
33,641 28,293 
Assets under constructionn/a93,687 100,339 
Property, plant and equipment, at cost953,947 795,064 
Accumulated depreciation(283,441)(214,816)
Property, plant and equipment, net$670,506 $580,248 
______________
(1)Lesser of remaining lease term, building life, or estimated useful life.
v3.22.2.2
INTANGIBLE ASSETS AND GOODWILL (Tables)
 9 Months Ended
Sep. 30, 2022
Goodwill and Intangible Assets Disclosure [Abstract]  
Schedule of net-book value and estimated remaining life and finite lived intangible assets
The following table summarizes the net-book-value and estimated remaining life of the Company’s intangible assets as of September 30, 2022:
(In thousands)Weighted Average Remaining Life (Years)Gross Carrying AmountAccumulated Amortization
Net Balance at September 30, 2022
Finite-lived intangible assets
Trade name12.7$104,000 $(18,840)$85,160 
Customer relationships8.34,000 (333)3,667 
Patents and licenses3.110,942 (7,805)3,137 
Acquired developed technology (1)7.9860,610 (224,884)635,726 
Total finite-lived intangible assets979,552 (251,862)727,690 
In-process research and developmentn/a1,250,000 — 1,250,000 
Total intangible assets$2,229,552 $(251,862)$1,977,690 
______________
(1)The gross carrying amount includes an immaterial foreign currency translation adjustment related to the intangible assets acquired as a result of the acquisition of OmicEra Diagnostics GmbH (“OmicEra”), whose functional currency is also its local currency. Intangible asset balances are translated into U.S. dollars using exchange rates in effect at period end, and adjustments related to foreign currency translation are included in other comprehensive income.
The following table summarizes the net-book-value and estimated remaining life of the Company’s intangible assets as of December 31, 2021:
(In thousands)Weighted Average Remaining Life (Years)Gross Carrying AmountAccumulated Amortization
Net balance at December 31, 2021
Finite-lived intangible assets
Trade name13.4$104,700 $(13,554)$91,146 
Customer relationships9.66,700 (1,577)5,123 
Patents and licenses3.610,942 (6,763)4,179 
Acquired developed technology8.6918,171 (176,402)741,769 
Supply agreements5.42,295 (101)2,194 
Total finite-lived intangible assets1,042,808 (198,397)844,411 
In-process research and developmentn/a1,250,000 — 1,250,000 
Total intangible assets$2,292,808 $(198,397)$2,094,411 
Schedule of estimated future amortization expense, intangible assets
As of September 30, 2022, the estimated future amortization expense associated with the Company’s finite-lived intangible assets for each of the five succeeding fiscal years is as follows:
(In thousands)
2022 (remaining three months)$22,913 
202391,653 
202491,319 
202590,271 
202689,211 
Thereafter342,323 
$727,690 
Schedule of carrying amount of goodwill
The change in the carrying amount of goodwill for the periods ended September 30, 2022 and December 31, 2021 is as follows:
(In thousands)
Balance, January 1, 2021
$1,237,672 
Thrive acquisition948,105 
Ashion acquisition56,758 
PreventionGenetics acquisition92,637 
Balance, December 31, 2021
2,335,172 
OmicEra acquisition10,809 
PreventionGenetics acquisition adjustment42 
Effects of changes in foreign currency exchange rates (1)(843)
Balance September 30, 2022
$2,345,180 
______________
(1)Represents the impact of foreign currency translation related to the goodwill acquired as a result of the acquisition of OmicEra. Goodwill balances are translated into U.S. dollars using exchange rates in effect at period end, and adjustments related to foreign currency translation are included in other comprehensive income.
v3.22.2.2
FAIR VALUE MEASUREMENTS (Tables)
 9 Months Ended
Sep. 30, 2022
Fair Value Disclosures [Abstract]  
Schedule of fair value measurements along with the level within the fair value hierarchy in which the fair value measurements fall
The following table presents the Company’s fair value measurements as of September 30, 2022 along with the level within the fair value hierarchy in which the fair value measurements, in their entirety, fall.
(In thousands)Fair Value at September 30, 2022Quoted Prices in Active Markets for Identical Assets (Level 1)Significant Other Observable Inputs (Level 2)Significant Unobservable Inputs (Level 3)
Cash, cash equivalents, and restricted cash
Cash and money market$173,968 $173,968 $— $— 
Commercial paper58,917 — 58,917 — 
U.S. government agency securities2,421 — 2,421 — 
Restricted cash297 297 — — 
Marketable securities
Corporate bonds$114,204 $— $114,204 $— 
Certificates of deposit5,500 — 5,500 — 
Commercial paper1,988 — 1,988 — 
U.S. government agency securities243,855 — 243,855 — 
Asset backed securities62,874 — 62,874 — 
Equity securities (1)5,387 5,387 — — 
Non-marketable securities$2,990 $— $— $2,990 
Liabilities
Contingent consideration$(305,925)$— $— $(305,925)
Total$366,476 $179,652 $489,759 $(302,935)
______________
(1)Inclusive of the American Depository Shares of MDxHealth received as part of the sale of the Company’s GPS test, which are restricted to a holding period of six months after the date of the sale of August 2, 2022. The shares have a fair value of $4.7 million as of September 30, 2022.
The following table presents the Company’s fair value measurements as of December 31, 2021 along with the level within the fair value hierarchy in which the fair value measurements, in their entirety, fall.
(In thousands)Fair Value at December 31, 2021Quoted Prices in Active Markets for Identical Assets (Level 1)Significant Other Observable Inputs (Level 2)Significant Unobservable Inputs (Level 3)
Cash and cash equivalents
Cash and money market$247,335 $247,335 $— $— 
Commercial paper64,593 — 64,593 — 
U.S. government agency securities3,543 — 3,543 — 
Restricted cash297 297 — — 
Marketable securities
U.S. government agency securities$249,920 $— $249,920 $— 
Corporate bonds313,154 — 313,154 — 
Asset backed securities94,460 — 94,460 — 
Certificates of deposit47,139 — 47,139 — 
Commercial paper6,996 — 6,996 — 
Equity securities3,336 3,336 — — 
Non-marketable securities$3,090 $— $— $3,090 
Liabilities
Contingent consideration$(359,021)$— $— $(359,021)
Total$674,842 $250,968 $779,805 $(355,931)
Schedule of fair value of contingent consideration
The following table provides a reconciliation of the beginning and ending balances of contingent consideration:
(In thousands)Contingent Consideration
Beginning balance, January 1, 2022$359,021 
Purchase price contingent consideration (1)4,600 
Changes in fair value(57,619)
Payments(77)
Ending balance, September 30, 2022
$305,925 
______________
(1)The increase in contingent consideration liability is due to the contingent consideration associated with the acquisition of OmicEra. Refer to Note 16 for further information.
v3.22.2.2
CONVERTIBLE NOTES (Tables)
 9 Months Ended
Sep. 30, 2022
CONVERTIBLE NOTES [Abstract]  
Schedule of convertible note obligations included in the condensed consolidated balance sheets
Convertible note obligations included in the condensed consolidated balance sheet consisted of the following as of September 30, 2022:
Fair Value (1)
(In thousands)Principal AmountUnamortized Debt Discount and Issuance CostsNet Carrying AmountAmountLeveling
2028 Convertible notes - 0.375%
$1,150,000 $(16,545)$1,133,455 $733,999 2
2027 Convertible notes - 0.375%
747,500 (10,011)737,489 521,987 2
2025 Convertible notes - 1.000%
315,005 (1,324)313,681 281,142 2
Convertible note obligations included in the condensed consolidated balance sheet consisted of the following as of December 31, 2021:
Fair Value (1)
(In thousands)Principal AmountUnamortized Debt Discount and Issuance CostsNet Carrying AmountAmountLeveling
2028 Convertible notes - 0.375%
$1,150,000 $(18,826)$1,131,174 $1,139,650 2
2027 Convertible notes - 0.375%
747,500 (11,691)735,809 771,794 2
2025 Convertible notes - 1.000%
315,005 (1,756)313,249 415,473 2
______________
(1)The fair values are based on observable market prices for this debt, which is traded in less active markets and therefore is classified as a Level 2 fair value measurement.
Schedule of allocation of transaction costs related to convertible debt The following table summarizes the original issuance costs at the time of issuance for each set of Notes:
(In thousands)
January 2025 Notes$10,284 
June 2025 Notes7,362 
2027 Notes14,285 
2028 Notes24,453 
Schedule of interest expense
Interest expense includes the following:
Three Months Ended September 30,Nine Months Ended September 30,
(In thousands)2022202120222021
Debt issuance costs amortization$1,444 $1,444 $4,284 $4,284 
Debt discount amortization37 37 110 110 
Coupon interest expense2,566 2,566 7,699 7,699 
Total interest expense on convertible notes$4,047 $4,047 $12,093 $12,093 
Schedule of effective interest rates related to convertible debt
The following table summarizes the effective interest rates of the Notes:
Three Months Ended September 30,Nine Months Ended September 30,
2022202120222021
2025 Convertible Notes1.18 %1.18 %1.18 %1.18 %
2027 Convertible Notes0.68 %0.68 %0.67 %0.67 %
2028 Convertible Notes0.64 %0.64 %0.64 %0.64 %
v3.22.2.2
STOCKHOLDERS' EQUITY (Tables)
 9 Months Ended
Sep. 30, 2022
Equity [Abstract]  
Schedule of amounts recognized in accumulated other comprehensive income (loss) (AOCI)
The amount recognized in AOCI for the nine months ended September 30, 2022 were as follows:
(In thousands)Foreign Currency Translation AdjustmentsUnrealized Gain (Loss) on Marketable Securities (1)Accumulated Other Comprehensive Income (Loss)
Balance at December 31, 2021$23 $(1,466)$(1,443)
Other comprehensive loss before reclassifications(3,176)(6,597)(9,773)
Amounts reclassified from accumulated other comprehensive loss— 146 146 
Net current period change in accumulated other comprehensive loss(3,176)(6,451)(9,627)
Balance at September 30, 2022$(3,153)$(7,917)$(11,070)
______________
(1)There was no tax impact from the amounts recognized in AOCI for the three and nine months ended September 30, 2022.
The amounts recognized in AOCI for the nine months ended September 30, 2021 were as follows:
(In thousands)Unrealized Gain (Loss) on Marketable SecuritiesAccumulated Other Comprehensive Income (Loss)
Balance at December 31, 2020$526 $526 
Other comprehensive loss before reclassifications(292)(292)
Amounts reclassified from accumulated other comprehensive income(271)(271)
Net current period change in accumulated other comprehensive income, before tax(563)(563)
Income tax benefit related to items of other comprehensive income170 170 
Balance at September 30, 2021$133 $133 
Schedule of amounts reclassified from accumulated other comprehensive income (loss)
Amounts reclassified from AOCI for the nine months ended September 30, 2022 and 2021 were as follows:
Affected Line Item in the
Statements of Operations		Nine Months Ended September 30,
Details about AOCI Components (In thousands)20222021
Change in value of available-for-sale investments
Sales and maturities of available-for-sale investmentsInvestment income (loss), net$146 $(271)
Total reclassifications$146 $(271)
v3.22.2.2
STOCK-BASED COMPENSATION (Tables)
 9 Months Ended
Sep. 30, 2022
Share-based Payment Arrangement [Abstract]  
Summary of Stock Option Activity Under the Stock Plans
A summary of stock option activity under the Stock Plans is as follows:
OptionsSharesWeighted Average Exercise PriceWeighted Average Remaining Contractual Term (Years)Aggregate Intrinsic Value (1)
(Aggregate intrinsic value in thousands)
Outstanding, January 1, 20222,284,276 $34.65 5.5
Granted— — 
Exercised(643,922)9.30 
Forfeited(52,465)77.53 
Outstanding, September 30, 20221,587,889 $43.60 5.1$14,366 
Vested and expected to vest, September 30, 2022
1,587,889 $43.60 5.1$14,366 
Exercisable, September 30, 20221,401,945 $37.53 4.8$14,052 
______________
(1)The total intrinsic value of options exercised during the nine months ended September 30, 2022 and 2021 was $34.7 million and $148.8 million, respectively, determined as of the date of exercise.
Summary of Restricted Stock and Restricted Stock Unit Activity Under the Stock Plans
A summary of restricted stock and restricted stock unit activity during the nine months ended September 30, 2022 is as follows:
Restricted stock and restricted stock unitsSharesWeighted Average Grant Date Fair Value (1)
Outstanding, January 1, 20224,320,910 $108.84 
Granted3,784,503 70.28 
Released (2)(1,629,309)95.46 
Forfeited(888,291)90.88 
Outstanding, September 30, 20225,587,813 $87.97 
______________
(1)The weighted average grant date fair value of the restricted stock units granted during the nine months ended September 30, 2021 was $133.80.
(2)The fair value of restricted stock units vested and converted to shares of the Company’s common stock was $155.5 million and $114.4 million during the nine months ended September 30, 2022 and 2021, respectively.
Share-based Payment Arrangement, Performance Shares, Activity
A summary of performance share unit activity is as follows:
Performance share unitsShares (1)Weighted Average Grant Date Fair Value (2)
Outstanding, January 1, 2022878,114 $107.18 
Granted805,782 89.43 
Released (3)(292,134)93.22 
Forfeited(373,372)91.91 
Outstanding, September 30, 20221,018,390 $102.74 
______________
(1)The performance share units listed above assumes attainment of maximum payout rates as set forth in the performance criteria. Applying actual or expected payout rates, the number of outstanding performance share units as of September 30, 2022 was 229,129.
(2)The weighted average grant date fair value of the performance share units granted during the nine months ended September 30, 2021 was $140.96.
(3)The fair value of performance share units vested and converted to shares of the Company’s common stock was $27.2 million for the nine months ended September 30, 2022. There were no performance share units vested and converted to shares of the Company’s common stock during the nine months ended September 30, 2021.
Schedule of share-based Payment Award, Employee Stock Purchase Plan, Valuation Assumptions
The fair value of ESPP shares is based on the assumptions in the following table:
Three Months Ended September 30,Nine Months Ended September 30,
2022202120222021
ESPP Shares
Risk-free interest rates
(1)
(1)
1.49% - 2.73%
0.04% - 0.16%
Expected term (in years)
(1)
(1)
0.5 - 2
0.5 - 2
Expected volatility
(1)
(1)
50.94% - 60.34%
48.38% - 68.51%
Dividend yield(1)(1)—%—%
______________
(1)The Company did not issue stock purchase rights under its 2010 Employee Stock Purchase Plan during the period indicated.
v3.22.2.2
COMMITMENTS AND CONTINGENCIES (Tables)
 9 Months Ended
Sep. 30, 2022
Commitments and Contingencies Disclosure [Abstract]  
Supplemental disclosure of cash flow information related to our operating leases
Supplemental disclosure of cash flow information related to the Company’s cash and non-cash activities with its leases are as follows:
Nine Months Ended September 30,
(In thousands)20222021
Cash paid for amounts included in the measurement of lease liabilities:
Operating cash flows from operating leases$24,579$19,835
Operating cash flows from finance leases520723
Finance cash flows from finance leases3,5883,805
Non-cash investing and financing activities:
Right-of-use assets obtained in exchange for new operating lease liabilities (1)$25,471$60,480
Right-of-use assets obtained in exchange for new finance lease liabilities8,2034,296
Weighted-average remaining lease term - operating leases (in years)7.608.14
Weighted-average remaining lease term - finance leases (in years)3.503.13
Weighted-average discount rate - operating leases6.34 %6.28 %
Weighted-average discount rate - finance leases6.51 %5.42 %
_____________
(1)For the nine months ended September 30, 2022, this includes right-of-use assets recorded as a result of the lease modification discussed below of $8.1 million. For the nine months ended September 30, 2021, this includes right-of-use assets acquired as part of the business combinations described in Note 16 of $39.6 million.
v3.22.2.2
ACQUISITIONS AND DIVESTITURES (Tables)
 9 Months Ended
Sep. 30, 2022
Business Combination and Asset Acquisition [Abstract]  
Schedule of Business Acquisitions, by Acquisition
The combination date fair value of the consideration transferred for OmicEra was approximately $19.4 million, which consisted of the following:
(In thousands)
Common stock issued$14,792 
Contingent consideration4,600 
Working capital adjustment to be settled in cash16 
Total purchase price$19,408 
Schedule of Recognized Identified Assets Acquired and Liabilities Assumed
The purchase price was allocated to the underlying assets acquired and liabilities assumed based upon their estimated fair values including immaterial measurement period adjustments as follows:
(In thousands)
Net operating assets$2,586 
Developed technology10,000 
Total identifiable assets acquired12,586 
Net operating liabilities(3,987)
Net identifiable assets acquired8,599 
Goodwill10,809 
Net assets acquired$19,408 
Schedule of Noncash or Part Noncash Divestitures
The closing date fair value of the consideration received for the asset was approximately $29.6 million, which consisted of the following:
(In thousands)
Cash$25,000 
MDxHealth American Depository Shares 4,631 
Contingent consideration— 
Total consideration$29,631 
v3.22.2.2
SEGMENT INFORMATION (Tables)
 9 Months Ended
Sep. 30, 2022
Segment Reporting [Abstract]  
Revenue from external customers by geographic areas
The following table summarizes total revenue from customers by geographic region. Product revenues are attributed to countries based on ship-to location.
Three Months Ended September 30,Nine Months Ended September 30,
(In thousands)2022202120222021
United States$491,540 $429,150 $1,441,748 $1,213,142 
Outside of United States31,533 27,229 89,536 80,133 
Total revenues$523,073 $456,379 $1,531,284 $1,293,275 
v3.22.2.2
SUMMARY OF SIGNIFICANT ACCOUNTING POLICIES - Net Loss Per Share (Details) - shares
shares in Thousands
 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Common shares not included in the computation of diluted net loss per share    
Potentially issuable common shares not included in the computation of diluted net loss per share because they would have an anti-dilutive effect 28,548 27,903
Shares issuable in connection with acquisitions    
Common shares not included in the computation of diluted net loss per share    
Potentially issuable common shares not included in the computation of diluted net loss per share because they would have an anti-dilutive effect 45 45
Shares issuable upon exercise of stock options    
Common shares not included in the computation of diluted net loss per share    
Potentially issuable common shares not included in the computation of diluted net loss per share because they would have an anti-dilutive effect 1,588 2,380
Shares issuable upon the release of restricted stock awards    
Common shares not included in the computation of diluted net loss per share    
Potentially issuable common shares not included in the computation of diluted net loss per share because they would have an anti-dilutive effect 5,588 4,306
Shares issuable upon the release of performance share units    
Common shares not included in the computation of diluted net loss per share    
Potentially issuable common shares not included in the computation of diluted net loss per share because they would have an anti-dilutive effect 1,018 863
Shares issuable upon conversion of convertible notes    
Common shares not included in the computation of diluted net loss per share    
Potentially issuable common shares not included in the computation of diluted net loss per share because they would have an anti-dilutive effect 20,309 20,309
v3.22.2.2
REVENUE - Schedule of Disaggregation of Revenue (Details) - USD ($)
$ in Thousands
 3 Months Ended 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Sep. 30, 2022
Sep. 30, 2021
Disaggregation of Revenue [Line Items]        
Revenue recognized $ 523,073 $ 456,379 $ 1,531,284 $ 1,293,275
Screening        
Disaggregation of Revenue [Line Items]        
Revenue recognized 360,759 280,378 1,021,175 784,643
Screening | Medicare Parts B & C        
Disaggregation of Revenue [Line Items]        
Revenue recognized 140,366 116,088 389,373 329,034
Screening | Commercial        
Disaggregation of Revenue [Line Items]        
Revenue recognized 188,923 151,245 531,789 419,268
Screening | Other        
Disaggregation of Revenue [Line Items]        
Revenue recognized 31,470 13,045 100,013 36,341
Precision Oncology        
Disaggregation of Revenue [Line Items]        
Revenue recognized 151,443 145,412 458,058 412,628
Precision Oncology | Medicare Parts B & C        
Disaggregation of Revenue [Line Items]        
Revenue recognized 47,038 51,607 152,224 144,753
Precision Oncology | Commercial        
Disaggregation of Revenue [Line Items]        
Revenue recognized 42,660 42,844 134,658 136,800
Precision Oncology | International        
Disaggregation of Revenue [Line Items]        
Revenue recognized 31,533 27,229 89,536 80,133
Precision Oncology | Other        
Disaggregation of Revenue [Line Items]        
Revenue recognized 30,212 23,732 81,640 50,942
COVID-19 Testing        
Disaggregation of Revenue [Line Items]        
Revenue recognized $ 10,871 $ 30,589 $ 52,051 $ 96,004
v3.22.2.2
REVENUE - Narrative (Details) - USD ($)
$ in Millions
 3 Months Ended 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Sep. 30, 2022
Sep. 30, 2021
Dec. 31, 2021
Disaggregation of Revenue [Line Items]          
Deferred revenue $ 2.3   $ 2.3   $ 1.0
Deferred revenue, revenue recognized during period   $ 0.2   $ 24.6  
COVID-19          
Disaggregation of Revenue [Line Items]          
Deferred revenue, revenue recognized during period       24.3  
Variable consideration          
Disaggregation of Revenue [Line Items]          
Revenue recognized from changes in transaction prices $ 6.4 $ 0.2 $ 17.6 $ 13.2  
v3.22.2.2
MARKETABLE SECURITIES - Schedule of Cash and Cash Equivalents (Details) - USD ($)
$ in Thousands
Sep. 30, 2022
Dec. 31, 2021
Sep. 30, 2021
Marketable securities      
Cash and money market $ 173,968 $ 247,335  
Cash equivalents 61,338 68,136  
Total cash, cash equivalents and restricted cash 235,306 315,471 $ 273,779
Equity securities 5,387 3,336  
Marketable securities 433,808 715,005  
Total cash, cash equivalents and marketable securities 669,114 1,030,476  
Marketable securities      
Marketable securities      
Available-for-sale debt securities $ 428,421 $ 711,669  
v3.22.2.2
MARKETABLE SECURITIES - Schedule of Available For Sale Securities (Details) - USD ($)
$ in Thousands
Sep. 30, 2022
Dec. 31, 2021
Available-for-sale securities    
Amortized Cost $ 497,676 $ 781,271
Gains in Accumulated Other Comprehensive Income (Loss) 0 17
Losses in Accumulated Other Comprehensive Income (Loss) (7,917) (1,483)
Estimated Fair Value 489,759 779,805
Cash equivalents    
Available-for-sale securities    
Amortized Cost 61,338 68,136
Gains in Accumulated Other Comprehensive Income (Loss) 0 0
Losses in Accumulated Other Comprehensive Income (Loss) 0 0
Estimated Fair Value 61,338 68,136
Marketable securities    
Available-for-sale securities    
Amortized Cost 436,338 713,135
Gains in Accumulated Other Comprehensive Income (Loss) 0 17
Losses in Accumulated Other Comprehensive Income (Loss) (7,917) (1,483)
Estimated Fair Value 428,421 711,669
Commercial paper | Cash equivalents    
Available-for-sale securities    
Amortized Cost 58,917 64,593
Gains in Accumulated Other Comprehensive Income (Loss) 0 0
Losses in Accumulated Other Comprehensive Income (Loss) 0 0
Estimated Fair Value 58,917 64,593
U.S. government agency securities | Cash equivalents    
Available-for-sale securities    
Amortized Cost 2,421 3,543
Gains in Accumulated Other Comprehensive Income (Loss) 0 0
Losses in Accumulated Other Comprehensive Income (Loss) 0 0
Estimated Fair Value 2,421 3,543
U.S. government agency securities | Marketable securities    
Available-for-sale securities    
Amortized Cost 248,351 250,793
Gains in Accumulated Other Comprehensive Income (Loss) 0 0
Losses in Accumulated Other Comprehensive Income (Loss) (4,496) (873)
Estimated Fair Value 243,855 249,920
Corporate bonds | Marketable securities    
Available-for-sale securities    
Amortized Cost 116,627 313,634
Gains in Accumulated Other Comprehensive Income (Loss) 0 13
Losses in Accumulated Other Comprehensive Income (Loss) (2,423) (493)
Estimated Fair Value 114,204 313,154
Certificates of deposit | Marketable securities    
Available-for-sale securities    
Amortized Cost 5,500 47,147
Gains in Accumulated Other Comprehensive Income (Loss) 0 2
Losses in Accumulated Other Comprehensive Income (Loss) 0 (10)
Estimated Fair Value 5,500 47,139
Commercial paper | Marketable securities    
Available-for-sale securities    
Amortized Cost 1,988 6,996
Gains in Accumulated Other Comprehensive Income (Loss) 0 0
Losses in Accumulated Other Comprehensive Income (Loss) 0 0
Estimated Fair Value 1,988 6,996
Asset backed securities | Marketable securities    
Available-for-sale securities    
Amortized Cost 63,872 94,565
Gains in Accumulated Other Comprehensive Income (Loss) 0 2
Losses in Accumulated Other Comprehensive Income (Loss) (998) (107)
Estimated Fair Value $ 62,874 $ 94,460
v3.22.2.2
MARKETABLE SECURITIES - Schedule of Underlying Maturities of AFS Securities (Details)
$ in Thousands
Sep. 30, 2022
USD ($)
Available-for-sale securities  
Due in one year or less, Cost $ 401,109
Due in one year or less, Fair Value 395,132
Due after one year through five years, Cost 96,567
Due after one year through five years, Fair Value 94,627
Cash equivalents  
Available-for-sale securities  
Due in one year or less, Cost 61,338
Due in one year or less, Fair Value 61,338
Due after one year through five years, Cost 0
Due after one year through five years, Fair Value 0
Cash equivalents | Commercial paper  
Available-for-sale securities  
Due in one year or less, Cost 58,917
Due in one year or less, Fair Value 58,917
Due after one year through five years, Cost 0
Due after one year through five years, Fair Value 0
Cash equivalents | U.S. government agency securities  
Available-for-sale securities  
Due in one year or less, Cost 2,421
Due in one year or less, Fair Value 2,421
Due after one year through five years, Cost 0
Due after one year through five years, Fair Value 0
Marketable securities  
Available-for-sale securities  
Due in one year or less, Cost 339,771
Due in one year or less, Fair Value 333,794
Due after one year through five years, Cost 96,567
Due after one year through five years, Fair Value 94,627
Marketable securities | Commercial paper  
Available-for-sale securities  
Due in one year or less, Cost 1,988
Due in one year or less, Fair Value 1,988
Due after one year through five years, Cost 0
Due after one year through five years, Fair Value 0
Marketable securities | U.S. government agency securities  
Available-for-sale securities  
Due in one year or less, Cost 238,617
Due in one year or less, Fair Value 234,274
Due after one year through five years, Cost 9,734
Due after one year through five years, Fair Value 9,581
Marketable securities | Corporate bonds  
Available-for-sale securities  
Due in one year or less, Cost 93,666
Due in one year or less, Fair Value 92,032
Due after one year through five years, Cost 22,961
Due after one year through five years, Fair Value 22,172
Marketable securities | Certificates of deposit  
Available-for-sale securities  
Due in one year or less, Cost 5,500
Due in one year or less, Fair Value 5,500
Due after one year through five years, Cost 0
Due after one year through five years, Fair Value 0
Marketable securities | Asset backed securities  
Available-for-sale securities  
Due in one year or less, Cost 0
Due in one year or less, Fair Value 0
Due after one year through five years, Cost 63,872
Due after one year through five years, Fair Value $ 62,874
v3.22.2.2
MARKETABLE SECURITIES - Schedule of Gross Unrealized Losses and Fair Values of Investments in an Unrealized Loss Position (Details)
$ in Thousands
Sep. 30, 2022
USD ($)
Marketable securities  
Total fair value of available-for-sale securities in a continuous unrealized loss position for less than twelve months $ 419,983
Total gross unrealized losses of available-for-sale securities in a continuous unrealized loss position for less than twelve months (7,917)
Debt securities, available-for-sale, continuous unrealized loss position, 12 months of longer 0
Debt securities, available-for-sale, continuous unrealized loss position, 12 months of longer, accumulated loss 0
Total fair value of available-for-sale securities in a continuous unrealized loss position 419,983
Total gross unrealized losses of available-for-sale securities in a continuous unrealized loss position (7,917)
Corporate bonds | Marketable securities  
Marketable securities  
Total fair value of available-for-sale securities in a continuous unrealized loss position for less than twelve months 114,204
Total gross unrealized losses of available-for-sale securities in a continuous unrealized loss position for less than twelve months (2,423)
Debt securities, available-for-sale, continuous unrealized loss position, 12 months of longer 0
Debt securities, available-for-sale, continuous unrealized loss position, 12 months of longer, accumulated loss 0
Total fair value of available-for-sale securities in a continuous unrealized loss position 114,204
Total gross unrealized losses of available-for-sale securities in a continuous unrealized loss position (2,423)
Asset backed securities | Marketable securities  
Marketable securities  
Total fair value of available-for-sale securities in a continuous unrealized loss position for less than twelve months 61,924
Total gross unrealized losses of available-for-sale securities in a continuous unrealized loss position for less than twelve months (998)
Debt securities, available-for-sale, continuous unrealized loss position, 12 months of longer 0
Debt securities, available-for-sale, continuous unrealized loss position, 12 months of longer, accumulated loss 0
Total fair value of available-for-sale securities in a continuous unrealized loss position 61,924
Total gross unrealized losses of available-for-sale securities in a continuous unrealized loss position (998)
U.S. government agency securities | Marketable securities  
Marketable securities  
Total fair value of available-for-sale securities in a continuous unrealized loss position for less than twelve months 243,855
Total gross unrealized losses of available-for-sale securities in a continuous unrealized loss position for less than twelve months (4,496)
Debt securities, available-for-sale, continuous unrealized loss position, 12 months of longer 0
Debt securities, available-for-sale, continuous unrealized loss position, 12 months of longer, accumulated loss 0
Total fair value of available-for-sale securities in a continuous unrealized loss position 243,855
Total gross unrealized losses of available-for-sale securities in a continuous unrealized loss position $ (4,496)
v3.22.2.2
INVENTORY (Details) - USD ($)
$ in Thousands
Sep. 30, 2022
Dec. 31, 2021
Inventory Disclosure [Abstract]    
Raw materials $ 56,829 $ 51,321
Semi-finished and finished goods 57,870 53,673
Total inventory $ 114,699 $ 104,994
v3.22.2.2
PROPERTY, PLANT AND EQUIPMENT - Schedule of Estimated Useful Lives (Details) - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2022
Dec. 31, 2021
Property, plant and equipment    
Property, plant and equipment, at cost $ 953,947 $ 795,064
Accumulated depreciation (283,441) (214,816)
Property, plant and equipment, net 670,506 580,248
Land    
Property, plant and equipment    
Property, plant and equipment, at cost 4,716 4,716
Leasehold and building improvements    
Property, plant and equipment    
Property, plant and equipment, at cost $ 179,025 147,083
Land improvements    
Property, plant and equipment    
Estimated Useful Life 15 years  
Property, plant and equipment, at cost $ 6,415 5,206
Buildings    
Property, plant and equipment    
Property, plant and equipment, at cost $ 271,858 210,560
Computer equipment and computer software    
Property, plant and equipment    
Estimated Useful Life 3 years  
Property, plant and equipment, at cost $ 132,416 109,119
Laboratory equipment    
Property, plant and equipment    
Property, plant and equipment, at cost 232,189 189,748
Furniture and fixtures    
Property, plant and equipment    
Property, plant and equipment, at cost 33,641 28,293
Assets under construction    
Property, plant and equipment    
Property, plant and equipment, at cost $ 93,687 $ 100,339
Minimum | Buildings    
Property, plant and equipment    
Estimated Useful Life 30 years  
Minimum | Laboratory equipment    
Property, plant and equipment    
Estimated Useful Life 3 years  
Minimum | Furniture and fixtures    
Property, plant and equipment    
Estimated Useful Life 3 years  
Maximum | Buildings    
Property, plant and equipment    
Estimated Useful Life 40 years  
Maximum | Laboratory equipment    
Property, plant and equipment    
Estimated Useful Life 10 years  
Maximum | Furniture and fixtures    
Property, plant and equipment    
Estimated Useful Life 10 years  
v3.22.2.2
PROPERTY, PLANT AND EQUIPMENT - Narrative (Details) - USD ($)
$ in Thousands
 3 Months Ended 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Sep. 30, 2022
Sep. 30, 2021
Property, plant and equipment        
Depreciation $ 25,000 $ 22,300 $ 73,541 $ 64,267
Assets under construction 93,700   93,700  
Buildings        
Property, plant and equipment        
Assets under construction 28,800   28,800  
Laboratory equipment        
Property, plant and equipment        
Assets under construction 38,900   38,900  
Leasehold and building improvements        
Property, plant and equipment        
Assets under construction 16,100   16,100  
Computer software        
Property, plant and equipment        
Assets under construction $ 9,900   $ 9,900  
v3.22.2.2
INTANGIBLE ASSETS AND GOODWILL - Schedule of Finite Lived Intangible Assets Net Balances and Weighted Average Useful Lives (Details) - USD ($)
$ in Thousands
 9 Months Ended 12 Months Ended
Sep. 30, 2022
Dec. 31, 2021
Finite-Lived Intangible Assets [Line Items]    
Gross Carrying Amount $ 979,552 $ 1,042,808
Accumulated Amortization (251,862) (198,397)
Intangibles, net 727,690 844,411
In-process research and development 1,250,000 1,250,000
Finite-lived and indefinite-lived intangible assets, gross 2,229,552 2,292,808
Finite-lived and indefinite-lived intangible assets, net $ 1,977,690 $ 2,094,411
Trade name    
Finite-Lived Intangible Assets [Line Items]    
Weighted-average remaining useful life of finite-lived intangible asset (in years) 12 years 8 months 12 days 13 years 4 months 24 days
Gross Carrying Amount $ 104,000 $ 104,700
Accumulated Amortization (18,840) (13,554)
Intangibles, net $ 85,160 $ 91,146
Customer relationships    
Finite-Lived Intangible Assets [Line Items]    
Weighted-average remaining useful life of finite-lived intangible asset (in years) 8 years 3 months 18 days 9 years 7 months 6 days
Gross Carrying Amount $ 4,000 $ 6,700
Accumulated Amortization (333) (1,577)
Intangibles, net $ 3,667 $ 5,123
Patents and licenses    
Finite-Lived Intangible Assets [Line Items]    
Weighted-average remaining useful life of finite-lived intangible asset (in years) 3 years 1 month 6 days 3 years 7 months 6 days
Gross Carrying Amount $ 10,942 $ 10,942
Accumulated Amortization (7,805) (6,763)
Intangibles, net $ 3,137 $ 4,179
Acquired developed technology    
Finite-Lived Intangible Assets [Line Items]    
Weighted-average remaining useful life of finite-lived intangible asset (in years) 7 years 10 months 24 days 8 years 7 months 6 days
Gross Carrying Amount $ 860,610 $ 918,171
Accumulated Amortization (224,884) (176,402)
Intangibles, net $ 635,726 $ 741,769
Supply agreements    
Finite-Lived Intangible Assets [Line Items]    
Weighted-average remaining useful life of finite-lived intangible asset (in years)   5 years 4 months 24 days
Gross Carrying Amount   $ 2,295
Accumulated Amortization   (101)
Intangibles, net   $ 2,194
v3.22.2.2
INTANGIBLE ASSETS AND GOODWILL - Schedule of Future Amortization Expense (Details) - USD ($)
$ in Thousands
Sep. 30, 2022
Dec. 31, 2021
Goodwill and Intangible Assets Disclosure [Abstract]    
2022 $ 22,913  
2023 91,653  
2024 91,319  
2025 90,271  
2026 89,211  
Thereafter 342,323  
Intangibles, net $ 727,690 $ 844,411
v3.22.2.2
INTANGIBLE ASSETS AND GOODWILL - Schedule of Changes in Goodwill (Details) - USD ($)
$ in Thousands
 9 Months Ended 12 Months Ended
Sep. 30, 2022
Dec. 31, 2021
Recognized Goodwill    
Beginning balance $ 2,335,172 $ 1,237,672
Goodwill, foreign currency translation gain (loss) (843)  
Ending balance 2,345,180 2,335,172
Thrive acquisition    
Recognized Goodwill    
Goodwill acquired   948,105
Ashion acquisition    
Recognized Goodwill    
Goodwill acquired   56,758
PreventionGenetics acquisition    
Recognized Goodwill    
Goodwill acquired   $ 92,637
PreventionGenetics acquisition adjustment 42  
OmicEra acquisition    
Recognized Goodwill    
Goodwill acquired $ 10,809  
v3.22.2.2
INTANGIBLE ASSETS AND GOODWILL - Narrative (Details) - USD ($)
 3 Months Ended 9 Months Ended
Sep. 30, 2022
Jun. 30, 2022
Sep. 30, 2021
Sep. 30, 2022
Sep. 30, 2021
Aug. 02, 2022
Dec. 31, 2021
Finite-Lived Intangible Assets [Line Items]              
Gross value of intangible asset $ 979,552,000     $ 979,552,000     $ 1,042,808,000
Finite-lived intangible assets, accumulated amortization 251,862,000     251,862,000     198,397,000
Intangibles, net 727,690,000     727,690,000     844,411,000
Impairment of long-lived assets 5,946,000   $ 20,210,000 12,537,000 $ 20,210,000    
Impairment losses 0   0 0 $ 0    
Supply agreements              
Finite-Lived Intangible Assets [Line Items]              
Gross value of intangible asset             2,295,000
Finite-lived intangible assets, accumulated amortization             101,000
Intangibles, net             2,194,000
Impairment of intangible assets, finite-lived 2,000,000            
Finite-lived intangible asset, net, derecognized related to sale of disposal group 0     0      
Acquired developed technology              
Finite-Lived Intangible Assets [Line Items]              
Gross value of intangible asset 860,610,000     860,610,000     918,171,000
Finite-lived intangible assets, accumulated amortization 224,884,000     224,884,000     176,402,000
Intangibles, net $ 635,726,000     $ 635,726,000     $ 741,769,000
Impairment of long-lived assets   $ 6,600,000          
In-process research and development              
Finite-Lived Intangible Assets [Line Items]              
Impairment of long-lived assets     $ 20,200,000        
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Oncotype DX Genomic Prostate Score Test              
Finite-Lived Intangible Assets [Line Items]              
Gross value of intangible asset           $ 59,000,000  
Finite-lived intangible assets, accumulated amortization           16,100,000  
Intangibles, net           $ 42,900,000  
v3.22.2.2
FAIR VALUE MEASUREMENTS - Schedule of Fair Value (Details) - USD ($)
$ in Thousands
Sep. 30, 2022
Dec. 31, 2021
Fair value measurements    
Equity securities $ 5,387 $ 3,336
Fair Value, Recurring    
Fair value measurements    
Restricted cash 297 297
Equity securities 5,387 3,336
Non-marketable securities 2,990 3,090
Contingent consideration (305,925) (359,021)
Total 366,476 674,842
Fair Value, Recurring | MDxHealth    
Fair value measurements    
Equity securities 4,700  
Fair Value, Recurring | Corporate bonds    
Fair value measurements    
Estimated Fair Value 114,204 313,154
Fair Value, Recurring | Certificates of deposit    
Fair value measurements    
Estimated Fair Value 5,500 47,139
Fair Value, Recurring | Commercial paper    
Fair value measurements    
Estimated Fair Value 1,988 6,996
Fair Value, Recurring | U.S. government agency securities    
Fair value measurements    
Estimated Fair Value 243,855 249,920
Fair Value, Recurring | Asset backed securities    
Fair value measurements    
Estimated Fair Value 62,874 94,460
Fair Value, Recurring | Cash and money market    
Fair value measurements    
Cash and cash equivalents, fair value 173,968 247,335
Fair Value, Recurring | Commercial paper    
Fair value measurements    
Cash and cash equivalents, fair value 58,917 64,593
Fair Value, Recurring | U.S. government agency securities    
Fair value measurements    
Cash and cash equivalents, fair value 2,421 3,543
Quoted Prices in Active Markets for Identical Assets (Level 1) | Fair Value, Recurring    
Fair value measurements    
Restricted cash 297 297
Equity securities 5,387 3,336
Non-marketable securities 0 0
Contingent consideration 0 0
Total 179,652 250,968
Quoted Prices in Active Markets for Identical Assets (Level 1) | Fair Value, Recurring | Corporate bonds    
Fair value measurements    
Estimated Fair Value 0 0
Quoted Prices in Active Markets for Identical Assets (Level 1) | Fair Value, Recurring | Certificates of deposit    
Fair value measurements    
Estimated Fair Value 0 0
Quoted Prices in Active Markets for Identical Assets (Level 1) | Fair Value, Recurring | Commercial paper    
Fair value measurements    
Estimated Fair Value 0 0
Quoted Prices in Active Markets for Identical Assets (Level 1) | Fair Value, Recurring | U.S. government agency securities    
Fair value measurements    
Estimated Fair Value 0 0
Quoted Prices in Active Markets for Identical Assets (Level 1) | Fair Value, Recurring | Asset backed securities    
Fair value measurements    
Estimated Fair Value 0 0
Quoted Prices in Active Markets for Identical Assets (Level 1) | Fair Value, Recurring | Cash and money market    
Fair value measurements    
Cash and cash equivalents, fair value 173,968 247,335
Quoted Prices in Active Markets for Identical Assets (Level 1) | Fair Value, Recurring | Commercial paper    
Fair value measurements    
Cash and cash equivalents, fair value 0 0
Quoted Prices in Active Markets for Identical Assets (Level 1) | Fair Value, Recurring | U.S. government agency securities    
Fair value measurements    
Cash and cash equivalents, fair value 0 0
Significant Other Observable Inputs (Level 2) | Fair Value, Recurring    
Fair value measurements    
Restricted cash 0 0
Equity securities 0 0
Non-marketable securities 0 0
Contingent consideration 0 0
Total 489,759 779,805
Significant Other Observable Inputs (Level 2) | Fair Value, Recurring | Corporate bonds    
Fair value measurements    
Estimated Fair Value 114,204 313,154
Significant Other Observable Inputs (Level 2) | Fair Value, Recurring | Certificates of deposit    
Fair value measurements    
Estimated Fair Value 5,500 47,139
Significant Other Observable Inputs (Level 2) | Fair Value, Recurring | Commercial paper    
Fair value measurements    
Estimated Fair Value 1,988 6,996
Significant Other Observable Inputs (Level 2) | Fair Value, Recurring | U.S. government agency securities    
Fair value measurements    
Estimated Fair Value 243,855 249,920
Significant Other Observable Inputs (Level 2) | Fair Value, Recurring | Asset backed securities    
Fair value measurements    
Estimated Fair Value 62,874 94,460
Significant Other Observable Inputs (Level 2) | Fair Value, Recurring | Cash and money market    
Fair value measurements    
Cash and cash equivalents, fair value 0 0
Significant Other Observable Inputs (Level 2) | Fair Value, Recurring | Commercial paper    
Fair value measurements    
Cash and cash equivalents, fair value 58,917 64,593
Significant Other Observable Inputs (Level 2) | Fair Value, Recurring | U.S. government agency securities    
Fair value measurements    
Cash and cash equivalents, fair value 2,421 3,543
Significant Unobservable Inputs (Level 3) | Fair Value, Recurring    
Fair value measurements    
Restricted cash 0 0
Equity securities 0 0
Non-marketable securities 2,990 3,090
Contingent consideration (305,925) (359,021)
Total (302,935) (355,931)
Significant Unobservable Inputs (Level 3) | Fair Value, Recurring | Corporate bonds    
Fair value measurements    
Estimated Fair Value 0 0
Significant Unobservable Inputs (Level 3) | Fair Value, Recurring | Certificates of deposit    
Fair value measurements    
Estimated Fair Value 0 0
Significant Unobservable Inputs (Level 3) | Fair Value, Recurring | Commercial paper    
Fair value measurements    
Estimated Fair Value 0 0
Significant Unobservable Inputs (Level 3) | Fair Value, Recurring | U.S. government agency securities    
Fair value measurements    
Estimated Fair Value 0 0
Significant Unobservable Inputs (Level 3) | Fair Value, Recurring | Asset backed securities    
Fair value measurements    
Estimated Fair Value 0 0
Significant Unobservable Inputs (Level 3) | Fair Value, Recurring | Cash and money market    
Fair value measurements    
Cash and cash equivalents, fair value 0 0
Significant Unobservable Inputs (Level 3) | Fair Value, Recurring | Commercial paper    
Fair value measurements    
Cash and cash equivalents, fair value 0 0
Significant Unobservable Inputs (Level 3) | Fair Value, Recurring | U.S. government agency securities    
Fair value measurements    
Cash and cash equivalents, fair value $ 0 $ 0
v3.22.2.2
FAIR VALUE MEASUREMENTS - Fair Value of Contingent Consideration (Details) - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Fair Value Disclosures [Abstract]    
Beginning balance $ 359,021  
Purchase price contingent consideration 4,600  
Change in amount of contingent consideration liability (57,619) $ 10,986
Payments (77)  
Ending balance $ 305,925  
v3.22.2.2
FAIR VALUE MEASUREMENTS - Narrative (Details)
 3 Months Ended 9 Months Ended
Sep. 30, 2022
USD ($)
Sep. 30, 2021
USD ($)
Sep. 30, 2022
USD ($)
Sep. 30, 2021
USD ($)
Dec. 31, 2021
USD ($)
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]          
Contingent consideration $ 305,925,000   $ 305,925,000   $ 359,021,000
Venture capital investment fund          
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]          
Investment owned, at fair value 3,400,000   3,400,000   $ 1,500,000
Committed capital     17,500,000    
Committed capital callable $ 14,200,000   $ 14,200,000    
Product development and other milestone-based payments | Weighted average | Measurement Input, Probability of Success          
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]          
Contingent consideration liability, measurement input 0.91   0.91   0.91
Product development and other milestone-based payments | Weighted average | Measurement Input, Present-value Factor          
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]          
Contingent consideration liability, measurement input 0.071   0.071   0.023
Foreign exchange forward          
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]          
Derivative, notional amount $ 29,700,000   $ 29,700,000   $ 46,700,000
Derivative, fair value 0   0   0
Gain (Loss) on derivative instruments, net, pretax 0 $ 0 0 $ 0  
Significant Unobservable Inputs (Level 3) | Fair value, nonrecurring          
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]          
Investment owned, at fair value 39,500,000   39,500,000   25,300,000
Realized (gain) loss on preferred stock investment 10,000,000        
Thrive and Ashion | Fair value          
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]          
Contingent consideration 304,800,000   304,800,000   357,800,000
Thrive and Ashion | Revenue and Other Performance-based Payments          
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]          
Contingent consideration 0   0    
Biomatrica, Inc | Revenue and Other Performance-based Payments          
Fair Value, Balance Sheet Grouping, Financial Statement Captions [Line Items]          
Contingent consideration $ 1,200,000   $ 1,200,000   $ 1,200,000
v3.22.2.2
LONG-TERM DEBT - Narrative (Details) - USD ($)
 1 Months Ended 3 Months Ended
Nov. 30, 2021
Dec. 31, 2021
Sep. 30, 2022
Jun. 29, 2022
Long-term debt        
Financing receivable, amount elected to collateralize     $ 50,000,000  
Securitized receivables        
Long-term debt        
Maximum borrowing capacity       $ 150,000,000
Line of credit facility, current borrowing capacity     99,700,000  
Long-term debt     $ 50,000,000  
Line of credit facility, interest rate at period end     4.59%  
Securitized receivables | Minimum        
Long-term debt        
Long-term debt       $ 50,000,000
Revolving loan agreement | Revolving loan agreement | Line of credit        
Long-term debt        
Maximum borrowing capacity $ 150,000,000      
Minimum market value covenant 150,000,000      
Maximum outstanding cash advances threshold $ 20,000,000      
Remaining borrowing capacity   $ 147,100,000 $ 147,100,000  
Revolving loan agreement | Revolving loan agreement | Line of credit | Daily bloomberg short-term bank yield index rate        
Long-term debt        
Variable rate 0.60%      
City letter of credit | Revolving loan agreement | Line of credit        
Long-term debt        
Proceeds from lines of credit   $ 2,900,000    
v3.22.2.2
CONVERTIBLE NOTES - Schedule of Convertible Notes (Details) - USD ($)
$ in Thousands
Sep. 30, 2022
Dec. 31, 2021
2028 Convertible Notes    
Long-term debt    
Coupon interest rate 0.375% 0.375%
Principal Amount $ 1,150,000 $ 1,150,000
Unamortized Debt Discount and Issuance Costs (16,545) (18,826)
Net Carrying Amount 1,133,455 1,131,174
2028 Convertible Notes | Significant Other Observable Inputs (Level 2) | Fair value    
Long-term debt    
Amount $ 733,999 $ 1,139,650
2027 Convertible Notes    
Long-term debt    
Coupon interest rate 0.375% 0.375%
Principal Amount $ 747,500 $ 747,500
Unamortized Debt Discount and Issuance Costs (10,011) (11,691)
Net Carrying Amount 737,489 735,809
2027 Convertible Notes | Significant Other Observable Inputs (Level 2) | Fair value    
Long-term debt    
Amount $ 521,987 $ 771,794
2025 Convertible Notes    
Long-term debt    
Coupon interest rate 1.00% 1.00%
Principal Amount $ 315,005 $ 315,005
Unamortized Debt Discount and Issuance Costs (1,324) (1,756)
Net Carrying Amount 313,681 313,249
2025 Convertible Notes | Significant Other Observable Inputs (Level 2) | Fair value    
Long-term debt    
Amount $ 281,142 $ 415,473
v3.22.2.2
CONVERTIBLE NOTES - Narrative (Details)
$ / shares in Units, $ in Thousands, shares in Millions
 3 Months Ended 9 Months Ended
Sep. 30, 2022
$ / shares
Sep. 30, 2021
Sep. 30, 2022
USD ($)
shares
$ / shares
Sep. 30, 2021
Long-term debt        
Principal amount, convertible note | $     $ 1  
Repurchase price, as percentage of principal amount, if company undergoes change of control     100  
Market price (in dollars per share) $ 32.49   $ 32.49  
2025 Convertible Notes        
Long-term debt        
Conversion rate, number of shares to be issued per $1,000 of principal amount (in shares)     13.26  
Conversion price (in dollars per share) $ 75.43   $ 75.43  
Convertible debt, if-converted (in shares) | shares     4.2  
Effective interest rate (as a percent) 1.18% 1.18% 1.18% 1.18%
Term     2 years 3 months 18 days  
2027 Convertible Notes        
Long-term debt        
Conversion rate, number of shares to be issued per $1,000 of principal amount (in shares)     8.96  
Conversion price (in dollars per share) $ 111.66   $ 111.66  
Convertible debt, if-converted (in shares) | shares     6.7  
Effective interest rate (as a percent) 0.68% 0.68% 0.67% 0.67%
Term     4 years 5 months 15 days  
2028 Convertible Notes        
Long-term debt        
Conversion rate, number of shares to be issued per $1,000 of principal amount (in shares)     8.21  
Conversion price (in dollars per share) $ 121.84   $ 121.84  
Convertible debt, if-converted (in shares) | shares     9.4  
Effective interest rate (as a percent) 0.64% 0.64% 0.64% 0.64%
Term     5 years 5 months 1 day  
v3.22.2.2
CONVERTIBLE NOTES - Schedule of Transaction Costs (Details)
$ in Thousands
 9 Months Ended
Sep. 30, 2022
USD ($)
January 2025 Notes  
Long-term debt  
Total transaction costs $ 10,284
June 2025 Notes  
Long-term debt  
Total transaction costs 7,362
2027 Notes  
Long-term debt  
Total transaction costs 14,285
2028 Notes  
Long-term debt  
Total transaction costs $ 24,453
v3.22.2.2
CONVERTIBLE NOTES - Summary of Interest Expense (Details) - USD ($)
$ in Thousands
 3 Months Ended 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Sep. 30, 2022
Sep. 30, 2021
Debt Disclosure [Abstract]        
Debt issuance costs amortization $ 1,444 $ 1,444 $ 4,284 $ 4,284
Debt discount amortization 37 37 110 110
Coupon interest expense 2,566 2,566 7,699 7,699
Total interest expense on convertible notes $ 4,047 $ 4,047 $ 12,093 $ 12,093
v3.22.2.2
CONVERTIBLE NOTES - Schedule of Effective Interest Rates Related to Convertible Debt (Details)
 3 Months Ended 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Sep. 30, 2022
Sep. 30, 2021
2025 Convertible Notes        
Schedule of Convertible notes [Line Items]        
Effective interest rate (as a percent) 1.18% 1.18% 1.18% 1.18%
2027 Convertible Notes        
Schedule of Convertible notes [Line Items]        
Effective interest rate (as a percent) 0.68% 0.68% 0.67% 0.67%
2028 Convertible Notes        
Schedule of Convertible notes [Line Items]        
Effective interest rate (as a percent) 0.64% 0.64% 0.64% 0.64%
v3.22.2.2
LICENSE AND COLLABORATION AGREEMENTS - Mayo (Details)
$ in Thousands
 3 Months Ended 9 Months Ended
Sep. 30, 2022
USD ($)
Sep. 30, 2021
USD ($)
Sep. 30, 2022
USD ($)
Sep. 30, 2021
USD ($)
Sep. 30, 2020
USD ($)
installment
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]          
Research and development expense $ 90,813 $ 75,356 $ 299,144 $ 297,158  
Licensing agreements | Mayo          
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]          
License agreement fees commitment         $ 6,300
Number of installments | installment         5
Period patent remains in effect     5 years    
Research and development expense $ 1,500 $ 1,300 $ 4,200 $ 3,500  
v3.22.2.2
LICENSE AND COLLABORATION AGREEMENTS - John Hopkins University (Details) - Thrive acquisition - Licensing agreements
$ in Millions
Jan. 05, 2021
USD ($)
Sales milestone range one  
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]  
Payments contingent on milestones $ 10.0
Collaborative arrangement sales milestone amount 500.0
Sales milestone range two  
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]  
Payments contingent on milestones 15.0
Collaborative arrangement sales milestone amount 1,000.0
Sales milestone range three  
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]  
Payments contingent on milestones 20.0
Collaborative arrangement sales milestone amount $ 1,500.0
v3.22.2.2
PFIZER PROMOTION AGREEMENT (Details) - Cologuard promotion agreement - Pfizer Inc - USD ($)
$ in Millions
 3 Months Ended 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Sep. 30, 2022
Sep. 30, 2021
Nov. 30, 2021
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]          
Contract termination fee         $ 35.9
Service fee based on incremental gross profits over specified baselines and royalties $ 2.5 $ 16.8 $ 7.5 $ 63.6  
Charges for promotion, sales and marketing $ 20.6 $ 30.2 $ 86.1 $ 88.0  
v3.22.2.2
STOCKHOLDERS' EQUITY - Narrative (Details) - USD ($)
shares in Millions, $ in Millions
 1 Months Ended
Dec. 31, 2021
Apr. 14, 2021
Jan. 11, 2021
Jan. 05, 2021
May 31, 2022
May 01, 2022
TARDIS technology            
Subsidiary or Equity Method Investee [Line Items]            
Payments to acquire productive assets (in shares)     0.2      
Stock issued to acquire productive assets, value     $ 27.3      
OmicEra diagnostics acquisition            
Subsidiary or Equity Method Investee [Line Items]            
Business acquisition, equity interest issued or issuable (in shares)         0.3  
Fair value of stock issued in acquisition           $ 14.8
PreventionGenetics acquisition            
Subsidiary or Equity Method Investee [Line Items]            
Business acquisition, equity interest issued or issuable (in shares) 1.1          
Fair value of stock issued in acquisition $ 84.2          
Ashion acquisition            
Subsidiary or Equity Method Investee [Line Items]            
Business acquisition, equity interest issued or issuable (in shares)   0.1        
Fair value of stock issued in acquisition   $ 16.2        
Thrive acquisition            
Subsidiary or Equity Method Investee [Line Items]            
Business acquisition, equity interest issued or issuable (in shares)       9.3    
Fair value of stock issued in acquisition       $ 1,190.0    
v3.22.2.2
STOCKHOLDERS' EQUITY - Schedule of OCI (Details) - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
AOCI Attributable to Parent, Net of Tax [Roll Forward]    
Beginning balance $ 3,387,636 $ 2,235,552
Other comprehensive loss before reclassifications (9,773) (292)
Amounts reclassified from accumulated other comprehensive income 146 (271)
Net current period change in accumulated other comprehensive income, before tax (9,627) (563)
Income tax benefit related to items of other comprehensive income   170
Ending balance 3,108,634 3,457,590
Foreign Currency Translation Adjustments    
AOCI Attributable to Parent, Net of Tax [Roll Forward]    
Beginning balance 23  
Other comprehensive loss before reclassifications (3,176)  
Amounts reclassified from accumulated other comprehensive income 0  
Net current period change in accumulated other comprehensive income, before tax (3,176)  
Ending balance (3,153)  
Unrealized Gain (Loss) on Marketable Securities    
AOCI Attributable to Parent, Net of Tax [Roll Forward]    
Beginning balance (1,466) 526
Other comprehensive loss before reclassifications (6,597) (292)
Amounts reclassified from accumulated other comprehensive income 146 (271)
Net current period change in accumulated other comprehensive income, before tax (6,451) (563)
Income tax benefit related to items of other comprehensive income   170
Ending balance (7,917) 133
Accumulated Other Comprehensive Income (Loss)    
AOCI Attributable to Parent, Net of Tax [Roll Forward]    
Beginning balance (1,443) 526
Ending balance $ (11,070) $ 133
v3.22.2.2
STOCKHOLDERS' EQUITY - Schedule of Amounts Reclassified from AOCI (Details) - Reclassification out of accumulated other comprehensive income - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Changes in Accumulated Other Comprehensive Income (Loss)    
Total reclassifications $ 146 $ (271)
Unrealized Gain (Loss) on Marketable Securities    
Changes in Accumulated Other Comprehensive Income (Loss)    
Investment income (loss), net $ 146 $ (271)
v3.22.2.2
STOCK-BASED COMPENSATION - Narrative (Details) - USD ($)
$ in Thousands
 1 Months Ended 3 Months Ended 9 Months Ended
Jan. 05, 2021
Jan. 31, 2022
Sep. 30, 2022
Sep. 30, 2021
Sep. 30, 2022
Sep. 30, 2021
Stock-based compensation            
Stock-based compensation expense     $ 49,500 $ 63,600 $ 160,900 $ 283,300
Noncash stock-based compensation expense         160,906 197,180
Proceeds from stock options exercised         6,000 13,400
Stock plans            
Stock-based compensation            
Unrecognized compensation cost     $ 416,100   $ 416,100  
Weighted average period for recognition of cost         2 years 9 months 18 days  
Thrive acquisition            
Stock-based compensation            
Noncash stock-based compensation expense       $ 4,500   $ 19,000
Thrive acquisition | General and administrative expense            
Stock-based compensation            
Accelerated vesting compensation expense $ 86,200          
Stock option | Thrive acquisition            
Stock-based compensation            
Accelerated vesting (in shares)       34,167   138,163
Restricted stock units | Thrive acquisition            
Stock-based compensation            
Accelerated vesting (in shares)       24,865   58,171
Performance share units            
Stock-based compensation            
Award performance period   3 years        
Performance share units | Minimum            
Stock-based compensation            
Award multiplier percentage   50.00%        
Performance share units | Maximum            
Stock-based compensation            
Award multiplier percentage   150.00%        
v3.22.2.2
STOCK-BASED COMPENSATION - Fair Value and Activity (Details) - Stock plans - USD ($)
$ / shares in Units, $ in Thousands
 9 Months Ended
Dec. 31, 2021
Sep. 30, 2022
Sep. 30, 2021
Shares      
Outstanding at the beginning of the period (in shares)   2,284,276  
Granted (in shares)   0  
Exercised (in shares)   (643,922)  
Forfeited (in shares)   (52,465)  
Outstanding at the end of the period (in shares) 2,284,276 1,587,889  
Vested and expected to vest at end of period (in shares)   1,587,889  
Exercisable at the end of the period (in shares)   1,401,945  
Weighted Average Exercise Price      
Outstanding at the beginning of the period (in dollars per share)   $ 34.65  
Granted (in dollars per share)   0  
Exercised (in dollars per share)   9.30  
Forfeited (in dollars per share)   77.53  
Outstanding at the end of the period (in dollars per share) $ 34.65 43.60  
Vested and expected to vest at end of period (in dollars per share)   43.60  
Exercisable at the end of the period (in dollars per share)   $ 37.53  
Weighted Average Remaining Contractual Term      
Outstanding 5 years 6 months 5 years 1 month 6 days  
Vested and expected to vest at end of period   5 years 1 month 6 days  
Exercisable at the end of the period   4 years 9 months 18 days  
Aggregate Intrinsic Value      
Outstanding at the end of the period   $ 14,366  
Vested and expected to vest at end of period   14,366  
Exercisable at the end of the period   14,052  
Total intrinsic value of options exercised   $ 34,700 $ 148,800
v3.22.2.2
STOCK-BASED COMPENSATION - Share-based Payment Arrangement, Restricted Stock and Restricted Stock Unit, Activity (Details) - USD ($)
$ / shares in Units, $ in Millions
 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Restricted Shares and RSUs    
Shares    
Outstanding at the beginning of the period (in shares) 4,320,910  
Granted (in shares) 3,784,503  
Released (in shares) (1,629,309)  
Forfeited (in shares) (888,291)  
Outstanding at the end of the period (in shares) 5,587,813  
Weighted Average Exercise Price    
Outstanding at the beginning of the period (in dollars per share) $ 108.84  
Granted (in dollars per share) 70.28  
Released (in dollars per share) 95.46  
Forfeited (in dollars per share) 90.88  
Outstanding at the end of the period (in dollars per share) $ 87.97  
Fair value of equity instruments other than options vested in period $ 155.5 $ 114.4
Restricted stock units    
Weighted Average Exercise Price    
Granted (in dollars per share)   $ 133.80
v3.22.2.2
STOCK-BASED COMPENSATION - Share-based Payment Arrangement, Performance Shares, Activity (Details) - Shares issuable upon the release of performance share units - USD ($)
 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Dec. 31, 2021
Stock-based compensation      
Outstanding (in shares) 1,018,390   878,114
Outstanding (in dollars per share) $ 102.74   $ 107.18
Granted (in shares) 805,782    
Granted (in dollars per share) $ 89.43 $ 140.96  
Released (in shares) (292,134)    
Released (in dollars per share) $ 93.22    
Forfeited (in shares) (373,372)    
Forfeited (in dollars per share) $ 91.91    
Number of outstanding performance share units (in shares) 229,129    
Fair value of equity instruments other than options vested in period $ 27,200,000 $ 0  
v3.22.2.2
STOCK-BASED COMPENSATION - Schedule of Share-based Payment Award, Employee Stock Purchase Plan, Valuation Assumptions (Details) - Employee stock
 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Stock-based compensation    
Risk-free interest rates, minimum (as a percent) 1.49% 0.04%
Risk-free interest rates, maximum (as a percent) 2.73% 0.16%
Expected volatility, minimum (as a percent) 50.94% 48.38%
Expected volatility, maximum (as a percent) 60.34% 68.51%
Dividend yield (as a percent) 0.00% 0.00%
Minimum    
Stock-based compensation    
Expected term (in years) 6 months 6 months
Maximum    
Stock-based compensation    
Expected term (in years) 2 years 2 years
v3.22.2.2
COMMITMENTS AND CONTINGENCIES - Supplemental Disclosure of Cash Flow Information (Details) - USD ($)
$ in Thousands
 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Cash paid for amounts included in the measurement of lease liabilities:    
Operating cash flows from operating leases $ 24,579 $ 19,835
Operating cash flows from finance leases 520 723
Finance cash flows from finance leases 3,588 3,805
Non-cash investing and financing activities:    
Right-of-use assets obtained in exchange for new operating lease liabilities 25,471 60,480
Right-of-use assets obtained in exchange for new finance lease liabilities $ 8,203 $ 4,296
Weighted-average remaining lease term - operating leases (in years) 7 years 7 months 6 days 8 years 1 month 20 days
Weighted-average remaining lease term - finance leases (in years) 3 years 6 months 3 years 1 month 17 days
Weighted-average discount rate - operating leases 6.34% 6.28%
Weighted-average discount rate - finance leases 6.51% 5.42%
Thrive acquisition    
Non-cash investing and financing activities:    
Right-of-use assets obtained in exchange for new operating lease liabilities   $ 39,600
v3.22.2.2
COMMITMENTS AND CONTINGENCIES - Additional Information (Details) - USD ($)
$ in Thousands
 3 Months Ended
Jun. 30, 2022
Sep. 30, 2022
Jun. 01, 2022
May 31, 2022
Dec. 31, 2021
Jun. 30, 2021
Lessee, Lease, Description [Line Items]            
Operating lease right-of-use assets   $ 175,945 $ 8,100   $ 174,225  
Additional amount to be recognized at lease commencement for the lease liability   211,700 $ 8,600   201,900  
Operating lease liability, current   27,054     19,710  
Operating lease liability, noncurrent   184,633     182,166  
Finance lease, right-of-use asset   $ 10,800   $ 10,300 18,200  
Finance lease, right-of-use asset, statement of financial position, extensible list   Other long-term assets, net        
Finance lease liability   $ 11,100   $ 10,800 18,700  
Finance lease liability, current   $ 3,100     $ 6,200  
Finance lease, liability, current, statement of financial position, extensible list   Other current liabilities     Other current liabilities  
Finance lease liability, noncurrent   $ 8,000     $ 12,500  
Finance lease, liability, noncurrent, statement of financial position, extensible list   Other long-term liabilities     Other long-term liabilities  
DOS Rule Investigation            
Lessee, Lease, Description [Line Items]            
Estimated civil damages           $ 48,200
Civil damages $ 53,800          
Loss Contingency Accrual   $ 10,000        
v3.22.2.2
WISCONSIN ECONOMIC DEVELOPMENT TAX CREDITS (Details)
$ in Millions
 1 Months Ended 3 Months Ended 9 Months Ended
Dec. 31, 2021
USD ($)
position
Feb. 28, 2015
USD ($)
position
Sep. 30, 2022
USD ($)
Sep. 30, 2022
USD ($)
Wisconsin economic development tax credit agreement        
Agreements        
Refundable tax credits available, contingent   $ 9.0    
Capital investment expenditures over specified period, requirement to earn the refundable tax credits   $ 26.3    
Full-time positions that must be created over a specified time period to earn the refundable tax credits | position   758    
Period over which the capital investment expenditures must be incurred and the creation of full-time positions must be completed   7 years    
Refundable tax credits earned     $ 9.0 $ 9.0
Refundable tax credit received     9.0 9.0
Amended wisconsin economic development tax credit agreement        
Agreements        
Capital investment expenditures over specified period, requirement to earn the refundable tax credits $ 350.0      
Full-time positions that must be created over a specified time period to earn the refundable tax credits | position 1,300      
Period over which the capital investment expenditures must be incurred and the creation of full-time positions must be completed 5 years      
Refundable tax credits earned $ 18.5   9.0 9.0
Credit earning rate 10.00%      
Maximum credits available to earn $ 7.0      
Refundable tax credit receivable     9.0 9.0
Amended wisconsin economic development tax credit agreement | Operating expense        
Agreements        
Amortization of tax credits     0.0 1.0
Amended wisconsin economic development tax credit agreement | Prepaid expenses and other current assets        
Agreements        
Refundable tax credit receivable     1.7 1.7
Amended wisconsin economic development tax credit agreement | Other long-term assets        
Agreements        
Refundable tax credit receivable     $ 7.3 $ 7.3
v3.22.2.2
ACQUISITIONS AND DIVESTITURES - Schedule of Business Acquisitions, by Acquisition (Details) - OmicEra
May 02, 2022
USD ($)
Business Acquisition [Line Items]  
Common stock issued $ 14,792,000
Contingent consideration 4,600,000
Working capital adjustment to be settled in cash 16,000
Total purchase price $ 19,408,000
v3.22.2.2
ACQUISITIONS AND DIVESTITURES - Narrative (Details)
$ / shares in Units, $ in Thousands
 3 Months Ended 9 Months Ended
Aug. 02, 2022
USD ($)
$ / shares
shares
May 02, 2022
USD ($)
$ / shares
shares
Dec. 31, 2021
USD ($)
test
Sep. 30, 2022
USD ($)
Sep. 30, 2022
USD ($)
Jun. 23, 2021
May 03, 2021
Business Acquisition [Line Items]              
Contingent consideration     $ 359,021 $ 305,925 $ 305,925    
Noncash or part noncash divestiture, amount of consideration received, fair value (in dollars per share) | $ / shares $ 6.70            
Intangibles, net     $ 844,411 727,690 727,690    
Period of lab testing services 24 months            
Disposal Group, Disposed of by Sale, Not Discontinued Operations | Oncotype DX Genomic Prostate Score Test              
Business Acquisition [Line Items]              
Total consideration $ 29,631            
Noncash or part noncash divestiture, amount of consideration received (in shares) | shares 691,171            
Contingent consideration, additional outcomes, value high $ 70,000            
Intangibles, net $ 42,900            
Disposal group, not discontinued operation, gain (loss) on disposal       $ 13,200 $ 13,200    
OmicEra              
Business Acquisition [Line Items]              
Business acquisition, equity interest issued or issuable (in shares) | shares   265,186          
Shares issued, price per share (in usd per share) | $ / shares   $ 55.78          
Contingent payment obligations   $ 6,000          
Contingent consideration   4,600          
Developed technology   $ 10,000          
Weighted-average remaining useful life of finite-lived intangible asset (in years)   16 years          
PreventionGenetics acquisition              
Business Acquisition [Line Items]              
Number of tests provided | test     5,000        
PFS Genomics              
Business Acquisition [Line Items]              
Asset acquisition, percentage of interest acquired             90.00%
Remaining interest in PFS           10.00%  
v3.22.2.2
ACQUISITIONS AND DIVESTITURES - Schedule of Recognized Identified Assets Acquired and Liabilities Assumed (Details) - USD ($)
$ in Thousands
Sep. 30, 2022
May 02, 2022
Dec. 31, 2021
Dec. 31, 2020
Preliminary estimated fair values of assets acquired and liabilities assumed:        
Goodwill $ 2,345,180   $ 2,335,172 $ 1,237,672
OmicEra        
Preliminary estimated fair values of assets acquired and liabilities assumed:        
Net operating assets   $ 2,586    
Developed technology   10,000    
Total identifiable assets acquired   12,586    
Net operating liabilities   (3,987)    
Net identifiable assets acquired   8,599    
Goodwill   10,809    
Net assets acquired   $ 19,408    
v3.22.2.2
ACQUISITIONS AND DIVESTITURES - Schedule of Noncash or Part Noncash Divestitures (Details) - Oncotype DX Genomic Prostate Score Test - Disposal Group, Disposed of by Sale, Not Discontinued Operations
$ in Thousands
Aug. 02, 2022
USD ($)
Income Statement, Balance Sheet and Additional Disclosures by Disposal Groups, Including Discontinued Operations [Line Items]  
Cash $ 25,000
MDxHealth American Depository Shares 4,631
Contingent consideration 0
Total consideration $ 29,631
v3.22.2.2
SEGMENT INFORMATION (Details)
$ in Thousands
 3 Months Ended 9 Months Ended
Sep. 30, 2022
USD ($)
Sep. 30, 2021
USD ($)
Sep. 30, 2022
USD ($)
segment
Sep. 30, 2021
USD ($)
Segment Reporting, Revenue Reconciling Item [Line Items]        
Revenue $ 523,073 $ 456,379 $ 1,531,284 $ 1,293,275
Number of operating segments | segment     1  
United States        
Segment Reporting, Revenue Reconciling Item [Line Items]        
Revenue 491,540 429,150 $ 1,441,748 1,213,142
Outside of United States        
Segment Reporting, Revenue Reconciling Item [Line Items]        
Revenue $ 31,533 $ 27,229 $ 89,536 $ 80,133
v3.22.2.2
INCOME TAXES (Details) - USD ($)
$ in Thousands
 3 Months Ended 9 Months Ended
Sep. 30, 2022
Sep. 30, 2021
Sep. 30, 2022
Sep. 30, 2021
Dec. 31, 2021
Income Tax Disclosure [Abstract]          
Tax expense (benefit) $ (3,116) $ (3,858) $ (6,882) $ (242,638)  
Deferred tax liabilities, net 22,900   22,900    
Unrecognized tax benefits $ 26,000   $ 26,000   $ 21,800