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Consolidated Statements of Cash Flows - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2024
Dec. 31, 2023
Dec. 31, 2022
Cash Flows from Operating Activities      
Net income $ 10,590.0 $ 5,240.4 $ 6,244.8
Adjustments to Reconcile Net Income to Cash Flows from Operating Activities:      
Depreciation and amortization 1,766.6 1,527.3 1,522.5
Change in deferred income taxes (2,683.1) (2,341.0) (2,185.2)
Stock-based compensation expense 645.6 628.5 371.1
Investment (gains) losses, net 49.8 23.5 420.0
Gains on sale of product rights (223.8) (1,878.9) (156.5)
Acquired in-process research and development 3,280.4 3,799.8 908.5
Other operating activities, net 777.4 295.5 461.3
Other changes in operating assets and liabilities, net of acquisitions and divestitures:      
Receivables—(increase) decrease (2,155.2) (2,451.0) (299.6)
Inventories—(increase) decrease (2,507.4) (1,425.0) (599.7)
Prepaid expenses and other assets—(increase) decrease (3,331.2) (3,453.4) (793.5)
Accounts payable and other liabilities—increase (decrease) 2,608.8 4,274.4 1,692.0
Net Cash Provided by Operating Activities 8,817.9 4,240.1 7,585.7
Cash Flows from Investing Activities      
Purchases of property and equipment (5,057.8) (3,447.6) (1,854.3)
Proceeds from sales and maturities of short-term investments 148.9 192.2 121.4
Purchases of short-term investments (98.5) (98.2) (107.4)
Proceeds from sales of and distributions from noncurrent investments 373.6 508.1 342.2
Purchases of noncurrent investments (677.3) (730.8) (600.2)
Proceeds from sale of product rights 601.3 1,604.3 95.8
Purchases of in-process research and development (3,345.8) (3,944.5) (1,131.0)
Cash paid for acquisitions, net of cash acquired (947.7) (1,044.3) (327.2)
Other investing activities, net (298.2) (191.9) (302.2)
Net Cash Used for Investing Activities (9,301.5) (7,152.7) (3,762.9)
Cash Flows from Financing Activities      
Dividends paid (4,680.4) (4,069.3) (3,535.8)
Net change in short-term borrowings (1,851.8) 4,691.4 1,498.0
Proceeds from issuance of long-term debt 11,417.1 3,958.5 0.0
Repayments of long-term debt (664.2) 0.0 (1,560.0)
Purchases of common stock (2,500.0) (750.0) (1,500.0)
Other financing activities, net (490.6) (335.0) (308.9)
Net Cash Provided by (Used for) Financing Activities 1,230.1 3,495.6 (5,406.7)
Effect of exchange rate changes on cash and cash equivalents (296.7) 168.6 (167.6)
Net increase (decrease) in cash and cash equivalents 449.8 751.6 (1,751.5)
Cash and cash equivalents at beginning of year 2,818.6 2,067.0 3,818.5
Cash and Cash Equivalents at End of Year $ 3,268.4 $ 2,818.6 $ 2,067.0