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CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Millions
 12 Months Ended
Dec. 31, 2022
Dec. 31, 2021
Dec. 31, 2020
Operating Activities:      
Net income $ 4,566 $ 6,201 $ 89
Adjustments to reconcile net income to net cash provided by operating activities:      
Depreciation expense 323 329 288
Amortization expense 1,780 1,721 1,192
Stock-based compensation expense 637 635 643
Deferred income taxes (1,552) (116) (214)
Net loss from equity securities 657 610 1,662
Acquired in-process research and development expenses 944 939 5,968
In-process research and development impairment 2,700 0 0
Other 780 576 178
Changes in operating assets and liabilities:      
Accounts receivable, net (406) 313 (1,171)
Inventories (310) 11 (195)
Prepaid expenses and other 70 (42) (214)
Accounts payable 226 (118) 80
Income taxes payable (568) (364) (778)
Accrued liabilities (775) 689 640
Net cash provided by operating activities 9,072 11,384 8,168
Investing Activities:      
Purchases of marketable debt securities (1,770) (3,517) (20,315)
Proceeds from sales of marketable debt securities 412 730 23,239
Proceeds from maturities of marketable debt securities 1,590 2,180 9,479
Acquisitions, including in-process research and development, net of cash acquired (1,797) (1,584) (25,920)
Purchases of equity securities (172) (380) (455)
Capital expenditures (728) (579) (650)
Other (1) 19 7
Net cash used in investing activities (2,466) (3,131) (14,615)
Financing Activities:      
Proceeds from debt financing, net of issuance costs 0 0 8,184
Proceeds from issuances of common stock 309 169 256
Repurchases of common stock (1,396) (546) (1,583)
Repayments of debt and other obligations (1,500) (4,750) (2,500)
Payment of dividends (3,709) (3,605) (3,449)
Other (173) (145) (138)
Net cash provided by (used in) financing activities (6,469) (8,877) 770
Effect of exchange rate changes on cash and cash equivalents (63) (35) 43
Net change in cash and cash equivalents 74 (659) (5,634)
Cash and cash equivalents at beginning of period 5,338 5,997 11,631
Cash and cash equivalents at end of period 5,412 5,338 5,997
Supplemental disclosure of cash flow information:      
Interest paid, net of amounts capitalized 907 979 951
Income taxes paid $ 3,136 $ 2,509 $ 2,639