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Segment and other information - Schedule of Reconciliation of Segment Net Income (Loss) to Consolidated Net Income (Loss) (Details) - USD ($)
$ in Millions
 3 Months Ended
Mar. 31, 2025
Mar. 31, 2024
Segment Reporting, Asset Reconciling Item [Line Items]    
Total revenues $ 8,149 $ 7,447
Manufacturing cost of sales 2,968 3,200
Interest income (126) (153)
Interest expense, net 723 824
Provision for income taxes 243 45
Net income (loss) 1,730 (113)
Amortization expense of intangible assets 1,200 1,200
Depreciation and right-of-use asset amortization expense 209 201
Reportable Segment    
Segment Reporting, Asset Reconciling Item [Line Items]    
Net income (loss) 1,730 (113)
Fair Value Adjustment to Inventory    
Segment Reporting, Asset Reconciling Item [Line Items]    
Amortization of step-up to fair value of inventory acquired 363 693
Operating Segments | Reportable Segment    
Segment Reporting, Asset Reconciling Item [Line Items]    
Total revenues 8,149 7,447
Manufacturing cost of sales 2,528 2,814
Profit share and royalties in cost of sales 440 386
Research and development 1,486 1,343
Sales and marketing 1,066 1,204
General and administrative 621 604
Other segment items (573) 520
Equity in loss (income) of equity method investments 11 (27)
Interest income (126) (153)
Interest expense, net 723 824
Provision for income taxes 243 45
Net income (loss) 1,730 (113)
Adjustments and reconciling items | Reportable Segment    
Segment Reporting, Asset Reconciling Item [Line Items]    
Net income (loss) 0 0
Product sales    
Segment Reporting, Asset Reconciling Item [Line Items]    
Total revenues 7,873 7,118
Product sales | Reportable Segment    
Segment Reporting, Asset Reconciling Item [Line Items]    
Total revenues 7,873 7,118
Other revenues    
Segment Reporting, Asset Reconciling Item [Line Items]    
Total revenues 276 329
Other revenues | Reportable Segment    
Segment Reporting, Asset Reconciling Item [Line Items]    
Total revenues $ 276 $ 329