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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS - USD ($)
$ in Millions
 9 Months Ended
Sep. 30, 2023
Sep. 30, 2022
Operating Activities:    
Net income $ 4,196 $ 2,933
Adjustments to reconcile net income to net cash provided by operating activities:    
Depreciation expense 263 240
Amortization expense 1,742 1,335
Stock-based compensation expense 565 463
Acquired in-process research and development expenses 808 786
In-process research and development impairment 0 2,700
Deferred income taxes (592) (1,214)
Net loss from equity securities 356 596
Other 260 546
Changes in operating assets and liabilities:    
Accounts receivable, net (63) (125)
Inventories (535) (34)
Prepaid expenses and other 71 (69)
Accounts payable (304) (38)
Income tax assets and liabilities, net (1,070) (483)
Accrued and other liabilities 141 (1,131)
Net cash provided by operating activities 5,837 6,505
Investing Activities:    
Purchases of marketable debt securities (1,474) (1,398)
Proceeds from sales of marketable debt securities 412 370
Proceeds from maturities of marketable debt securities 985 1,232
Acquisitions, including in-process research and development, net of cash acquired (873) (1,579)
Purchases of equity securities (218) (166)
Capital expenditures (370) (547)
Other 0 (3)
Net cash used in investing activities (1,538) (2,091)
Financing Activities:    
Proceeds from debt financing, net of issuance costs 1,979 0
Proceeds from issuances of common stock 206 133
Repurchases of common stock under repurchase programs (850) (604)
Repayments of debt and other obligations (2,250) (1,500)
Payments of dividends (2,866) (2,794)
Other (245) (150)
Net cash used in financing activities (4,026) (4,915)
Effect of exchange rate changes on cash and cash equivalents 20 (138)
Net change in cash and cash equivalents 293 (639)
Cash and cash equivalents at beginning of period 5,412 5,338
Cash and cash equivalents at end of period $ 5,705 $ 4,699