Segment and other information - Schedule of Reconciliation of Segment Net Income to Consolidated Net Income (Details) - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2024	Dec. 31, 2023	Dec. 31, 2022
Segment Reporting, Asset Reconciling Item [Line Items]
Total revenues	$ 33,424	$ 28,190	$ 26,323
Manufacturing cost of sales	12,858	8,451	6,406
Equity in (income) loss of equity method investments	(10)	11	891
Interest income	(510)	(1,200)	(127)
Interest expense, net	3,155	2,875	1,406
Provision for income taxes	519	1,138	794
Net income	4,090	6,717	6,552
Amortization expense of intangible assets	4,800	3,200	2,600
Depreciation and right-of-use asset amortization expense	805	824	818
Fair Value Adjustment to Inventory
Segment Reporting, Asset Reconciling Item [Line Items]
Amortization of step-up to fair value of inventory acquired	2,400	656	30
Operating Segments
Segment Reporting, Asset Reconciling Item [Line Items]
Total revenues	33,424	28,190	26,323
Manufacturing cost of sales	11,118	7,347	5,776
Profit share and royalties in cost of sales	1,740	1,104	630
Research and development	5,964	4,784	4,434
Sales and marketing	4,713	3,784	3,736
General and administrative	2,383	2,395	1,678
Other segment items	262	(743)	777
Equity in (income) loss of equity method investments	(10)	14	667
Interest income	(510)	(1,225)	(127)
Interest expense, net	3,155	2,875	1,406
Provision for income taxes	519	1,138	794
Net income	4,090	6,717	6,552
Adjustments and reconciling items
Segment Reporting, Asset Reconciling Item [Line Items]
Net income	0	0	0
Product sales
Segment Reporting, Asset Reconciling Item [Line Items]
Total revenues	32,026	26,910	24,801
Other revenues
Segment Reporting, Asset Reconciling Item [Line Items]
Total revenues	$ 1,398	$ 1,280	$ 1,522