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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 9 Months Ended
Sep. 30, 2025
Sep. 30, 2024
Sep. 30, 2025
Sep. 30, 2024
Segment Reporting, Asset Reconciling Item [Line Items]        
Total revenues $ 9,557 $ 8,503 $ 26,885 $ 24,338
Manufacturing cost of sales 3,082 3,310 9,061 9,746
Interest income (99) (126) (311) (394)
Interest expense, net 685 776 2,102 2,408
Provision for income taxes 705 271 1,084 364
Net income 3,216 2,830 6,378 3,463
Amortization expense of intangible assets 1,100 1,200 3,400 3,600
Depreciation and right-of-use asset amortization expense 232 198 661 601
Reportable Segment        
Segment Reporting, Asset Reconciling Item [Line Items]        
Net income 3,216 2,830 6,378 3,463
Fair Value Adjustment to Inventory        
Segment Reporting, Asset Reconciling Item [Line Items]        
Amortization of step-up to fair value of inventory acquired 338 661 1,000 2,000
Operating Segments | Reportable Segment        
Segment Reporting, Asset Reconciling Item [Line Items]        
Total revenues 9,557 8,503 26,885 24,338
Manufacturing cost of sales 2,508 2,852 7,520 8,491
Profit share and royalties in cost of sales 574 458 1,541 1,255
Research and development 1,900 1,450 5,130 4,240
Sales and marketing 1,097 1,117 3,300 3,532
General and administrative 623 508 1,798 1,686
Other segment items (1,642) (1,661) (1,676) (696)
Equity in (income) loss of equity method investments (10) 28 19 (11)
Interest income (99) (126) (311) (394)
Interest expense, net 685 776 2,102 2,408
Provision for income taxes 705 271 1,084 364
Net income 3,216 2,830 6,378 3,463
Adjustments and reconciling items | Reportable Segment        
Segment Reporting, Asset Reconciling Item [Line Items]        
Net income 0 0 0 0
Product sales        
Segment Reporting, Asset Reconciling Item [Line Items]        
Total revenues 9,137 8,151 25,781 23,310
Product sales | Reportable Segment        
Segment Reporting, Asset Reconciling Item [Line Items]        
Total revenues 9,137 8,151 25,781 23,310
Other revenues        
Segment Reporting, Asset Reconciling Item [Line Items]        
Total revenues 420 352 1,104 1,028
Other revenues | Reportable Segment        
Segment Reporting, Asset Reconciling Item [Line Items]        
Total revenues $ 420 $ 352 $ 1,104 $ 1,028