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Goodwill and other intangible assets - Narrative (Details) - USD ($)
$ in Millions
 3 Months Ended 9 Months Ended
Sep. 30, 2025
Mar. 31, 2025
Sep. 30, 2024
Sep. 30, 2025
Sep. 30, 2024
Jun. 30, 2025
Dec. 31, 2024
Finite-Lived Intangible Assets [Line Items]              
Finite-lived intangible assets, net $ 22,429     $ 22,429     $ 26,639
Impairment charge 400     1,200      
Intangible assets, net 23,139     23,139     27,699
Amortization charges associated with finite-lived intangible assets 1,100   $ 1,200 3,400 $ 3,600    
Total estimated amortization of finite-lived intangible assets for the remainder of the year 900     900      
Total estimated amortization of finite-lived intangible assets for 2026 3,600     3,600      
Total estimated amortization of finite-lived intangible assets for 2027 3,500     3,500      
Total estimated amortization of finite-lived intangible assets for 2028 2,800     2,800      
Total estimated amortization of finite-lived intangible assets for 2029 2,300     2,300      
Total estimated amortization of finite-lived intangible assets for 2030 2,200     2,200      
Developed-product-technology rights              
Finite-Lived Intangible Assets [Line Items]              
Finite-lived intangible assets, net 21,919     21,919     $ 26,017
Otezla | Developed-product-technology rights              
Finite-Lived Intangible Assets [Line Items]              
Finite-lived intangible assets, fair value disclosure 3,000 $ 4,000   3,000      
Finite-lived intangible assets, net 3,400 4,800   $ 3,400      
Impairment charge $ 400 $ 800          
UPLIZNA | In-process research and development              
Finite-Lived Intangible Assets [Line Items]              
Intangible assets, net           $ 350  
UPLIZNA | In-process research and development              
Finite-Lived Intangible Assets [Line Items]              
Finite-lived intangible asset, useful life           11 years