Consolidated Statements of Cash Flows - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2023	Dec. 31, 2022	Dec. 31, 2021
Cash Flows from Operating Activities
Net income	$ 5,240.4	$ 6,244.8	$ 5,581.7
Adjustments to Reconcile Net Income to Cash Flows from Operating Activities:
Depreciation and amortization	1,527.3	1,522.5	1,547.6
Debt extinguishment loss (Note 11)	0.0	0.0	405.2
Change in deferred income taxes	(2,341.0)	(2,185.2)	(802.3)
Stock-based compensation expense	628.5	371.1	342.8
Net investment (gains) losses	23.5	420.0	(178.0)
Gains on sale of product rights	(1,878.9)	(156.5)	(216.0)
Acquired in-process research and development (Note 3)	3,799.8	908.5	970.1
Other operating activities, net	295.5	461.3	727.4
Other changes in operating assets and liabilities, net of acquisitions and divestitures:
Receivables—(increase) decrease	(2,451.0)	(299.6)	(1,278.3)
Inventories—(increase) decrease	(1,425.0)	(599.7)	(235.9)
Other assets—(increase) decrease	(3,453.4)	(793.5)	1,515.4
Accounts payable and other liabilities—increase (decrease)	4,274.4	1,692.0	(1,013.8)
Net Cash Provided by Operating Activities	4,240.1	7,585.7	7,365.9
Cash Flows from Investing Activities
Purchases of property and equipment	(3,447.6)	(1,854.3)	(1,309.8)
Proceeds from sales and maturities of short-term investments	192.2	121.4	47.4
Purchases of short-term investments	(98.2)	(107.4)	(83.5)
Proceeds from sales of and distributions from noncurrent investments	508.1	342.2	800.0
Purchases of noncurrent investments	(730.8)	(600.2)	(929.9)
Proceeds from sale of product rights	1,604.3	95.8	216.0
Purchases of in-process research and development	(3,944.5)	(1,131.0)	(668.6)
Cash paid for acquisitions, net of cash acquired (Note 3)	(1,044.3)	(327.2)	(747.4)
Other investing activities, net	(191.9)	(302.2)	(191.7)
Net Cash Used for Investing Activities	(7,152.7)	(3,762.9)	(2,867.5)
Cash Flows from Financing Activities
Dividends paid	(4,069.3)	(3,535.8)	(3,086.8)
Net change in short-term borrowings	4,691.4	1,498.0	(4.0)
Proceeds from issuance of long-term debt	3,958.5	0.0	2,410.8
Repayments of long-term debt	0.0	(1,560.0)	(1,905.4)
Purchases of common stock	(750.0)	(1,500.0)	(1,250.0)
Other financing activities, net	(335.0)	(308.9)	(295.9)
Net Cash Provided by (Used for) Financing Activities	3,495.6	(5,406.7)	(4,131.3)
Effect of exchange rate changes on cash and cash equivalents	168.6	(167.6)	(205.7)
Net increase (decrease) in cash and cash equivalents	751.6	(1,751.5)	161.4
Cash and cash equivalents at beginning of year	2,067.0	3,818.5	3,657.1
Cash and Cash Equivalents at End of Year	$ 2,818.6	$ 2,067.0	$ 3,818.5