Condensed Consolidated Statements of Cash Flows - USD ($) $ in Millions	6 Months Ended
	Jun. 30, 2023	Jun. 30, 2022
Cash flows from operating activities:
Net income	$ 1,615.5	$ 1,572.6
Adjustments to reconcile net income to net cash provided by operating activities:
Stock-based compensation expense	241.7	244.2
Depreciation expense	80.2	73.2
Deferred income taxes	(290.0)	(241.7)
(Gains) losses on equity securities	(6.0)	159.8
Decrease in fair value of contingent consideration	(2.5)	(56.7)
Other non-cash items, net	11.1	(6.3)
Changes in operating assets and liabilities:
Accounts receivable, net	(93.4)	(249.3)
Inventories	(155.4)	(31.3)
Prepaid expenses and other assets	26.6	85.3
Accounts payable	71.3	30.8
Accrued expenses	417.4	547.1
Other liabilities	117.8	(31.7)
Net cash provided by operating activities	2,034.3	2,096.0
Cash flows from investing activities:
Purchases of available-for-sale debt securities	(2,390.8)	(227.9)
Maturities of available-for-sale debt securities	289.8	242.3
Purchases of property and equipment	(101.7)	(116.9)
Sale of equity securities	95.1	0.0
Investment in equity securities and notes receivable	(29.9)	(10.0)
Net cash used in investing activities	(2,137.5)	(112.5)
Cash flows from financing activities:
Issuances of common stock under benefit plans	72.8	98.1
Repurchases of common stock	(161.1)	0.0
Payments in connection with common stock withheld for employee tax obligations	(169.7)	(121.9)
Payments on finance leases	(21.6)	(25.6)
Other financing activities	2.2	1.7
Net cash used in financing activities	(277.4)	(47.7)
Effect of changes in exchange rates on cash	22.0	(31.8)
Net (decrease) increase in cash, cash equivalents and restricted cash	(358.6)	1,904.0
Cash, cash equivalents and restricted cash—beginning of period	10,512.0	6,800.1
Cash, cash equivalents and restricted cash—end of period	10,153.4	8,704.1
Supplemental disclosure of cash flow information:
Cash paid for income taxes	618.7	478.3
Cash paid for interest	$ 22.0	$ 27.1