Condensed Consolidated Statements of Cash Flows - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022
Cash flows from operating activities:
Net income	$ 2,650.8	$ 2,503.1
Adjustments to reconcile net income to net cash provided by operating activities:
Stock-based compensation expense	372.6	379.8
Depreciation expense	122.3	109.9
Deferred income taxes	(405.5)	(424.0)
Losses on equity securities	0.2	143.1
Decrease in fair value of contingent consideration	(1.3)	(59.3)
Other non-cash items, net	(9.6)	(32.8)
Changes in operating assets and liabilities:
Accounts receivable, net	(99.5)	(368.8)
Inventories	(252.9)	(58.1)
Prepaid expenses and other assets	(94.4)	(41.9)
Accounts payable	80.5	(39.1)
Accrued expenses	786.1	980.3
Other liabilities	153.4	(40.7)
Net cash provided by operating activities	3,302.7	3,051.5
Cash flows from investing activities:
Purchases of available-for-sale debt securities	(2,798.0)	(417.8)
Sales and maturities of available-for-sale debt securities	621.0	435.9
Purchases of property and equipment	(142.3)	(171.1)
Sale of equity securities	95.1	0.0
Investment in equity securities and notes receivable	(31.0)	(47.8)
Payment to acquire ViaCyte, Inc., net of cash acquired	0.0	(295.9)
Net cash used in investing activities	(2,255.2)	(496.7)
Cash flows from financing activities:
Issuances of common stock under benefit plans	88.2	134.7
Repurchases of common stock	(278.1)	0.0
Payments in connection with common stock withheld for employee tax obligations	(222.9)	(169.9)
Payments on finance leases	(32.9)	(75.1)
Other financing activities	3.3	2.4
Net cash used in financing activities	(442.4)	(107.9)
Effect of changes in exchange rates on cash	(0.5)	(70.0)
Net increase in cash, cash equivalents and restricted cash	604.6	2,376.9
Cash, cash equivalents and restricted cash—beginning of period	10,512.0	6,800.1
Cash, cash equivalents and restricted cash—end of period	11,116.6	9,177.0
Supplemental disclosure of cash flow information:
Cash paid for income taxes	919.1	840.1
Cash paid for interest	$ 32.6	$ 41.1