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CONDENSED CONSOLIDATED STATEMENTS OF CASH FLOWS (unaudited) - USD ($)
$ in Millions
 9 Months Ended
Sep. 30, 2024
Sep. 30, 2023
Operating Activities:    
Net (loss) income $ (1,303) $ 4,196
Adjustments to reconcile net (loss) income to net cash provided by operating activities:    
Depreciation expense 286 263
Amortization expense 1,788 1,742
Stock-based compensation expense 613 565
Deferred income taxes (1,465) (592)
Net loss from equity securities 148 356
Acquired in-process research and development expenses 4,674 808
In-process research and development impairment 4,180 0
Other 294 260
Changes in operating assets and liabilities:    
Accounts receivable, net 67 (63)
Inventories (200) (535)
Prepaid expenses and other (113) 71
Accounts payable 348 (304)
Income tax assets and liabilities, net (1,268) (1,070)
Accrued and other liabilities (197) 141
Net cash provided by operating activities 7,853 5,837
Investing Activities:    
Purchases of marketable debt securities (244) (1,474)
Proceeds from sales of marketable debt securities 2,265 412
Proceeds from maturities of marketable debt securities 327 985
Acquisitions, including in-process research and development, net of cash acquired (4,765) (873)
Purchases of equity securities (453) (218)
Capital expenditures (376) (370)
Other 23 0
Net cash used in investing activities (3,224) (1,538)
Financing Activities:    
Proceeds from debt financing, net of issuance costs 0 1,979
Proceeds from issuances of common stock 249 206
Repurchases of common stock under repurchase programs (800) (850)
Repayments of debt and other obligations (1,963) (2,250)
Payments of dividends (2,945) (2,866)
Other (234) (245)
Net cash used in financing activities (5,693) (4,026)
Effect of exchange rate changes on cash and cash equivalents 15 20
Net change in cash and cash equivalents (1,049) 293
Cash and cash equivalents at beginning of period 6,085 5,412
Cash and cash equivalents at end of period $ 5,037 $ 5,705