Income Taxes (Tables)

12 Months Ended

Dec. 31, 2021

Income Tax Disclosure [Abstract]

Schedule of earnings before income tax expense

Earnings Before Income Tax Expense

years ended December 31 (in millions)	2021		2020		2019
Domestic	$	(1,644)	$	(4,467)	$	(2,784)
Foreign	14,633		7,865		11,210
Total earnings before income tax expense	$	12,989	$	3,398	$	8,426

Schedule of income tax expense

Income Tax Expense

years ended December 31 (in millions)	2021		2020		2019
Current
Domestic	$	1,987	$	907	$	102
Foreign	351		194		320
Total current taxes	$	2,338	$	1,101	$	422
Deferred
Domestic	$	(839)	$	(58)	$	(137)
Foreign	(59)		(2,267)		259
Total deferred taxes	$	(898)	$	(2,325)	$	122
Total income tax expense (benefit)	$	1,440	$	(1,224)	$	544

Summary of effective tax rate reconciliation

Effective Tax Rate Reconciliation

years ended December 31	2021		2020		2019
Statutory tax rate	21.0	%	21.0	%	21.0	%
Effect of foreign operations	(5.4)		2.4		(8.4)
U.S. tax credits	(2.8)		(10.6)		(3.3)
Impacts related to U.S. tax reform	—		(1.1)		(1.6)
Non-deductible expenses	0.3		7.2		1.0
Tax law changes and related restructuring	(2.0)		(48.5)		3.1
Tax audit settlements	(0.4)		(5.1)		(4.7)
All other, net	0.4		(1.3)		(0.6)
Effective tax rate	11.1	%	(36.0	%)	6.5	%

Schedule of deferred tax assets and liabilities

Deferred Tax Assets and Liabilities

as of December 31 (in millions)	2021		2020
Deferred tax assets
Compensation and employee benefits	$	937	$	1,109
Accruals and reserves	667		438
Chargebacks and rebates	837		555
Advance payments	809		324
Net operating losses and other credit carryforwards	10,095		2,765
Other	1,234		1,371
Total deferred tax assets	14,579		6,562
Valuation allowances	(9,391)		(1,203)
Total net deferred tax assets	5,188		5,359
Deferred tax liabilities
Excess of book basis over tax basis of intangible assets	(4,711)		(5,274)
Excess of book basis over tax basis in investments	(308)		(335)
Other	(904)		(982)
Total deferred tax liabilities	(5,923)		(6,591)
Net deferred tax liabilities	$	(735)	$	(1,232)

Schedule of unrecognized tax benefits

Unrecognized Tax Benefits

years ended December 31 (in millions)	2021		2020		2019
Beginning balance	$	5,264	$	2,661	$	2,852
Increase due to acquisition	—		2,674		—
Increase due to current year tax positions	208		91		113
Increase due to prior year tax positions	137		59		499
Decrease due to prior year tax positions	(62)		(7)		(21)
Settlements	(24)		(141)		(749)
Lapse of statutes of limitations	(34)		(73)		(33)
Ending balance	$	5,489	$	5,264	$	2,661