Condensed Consolidated Statements of Cash Flows - USD ($) $ in Millions	9 Months Ended
	Sep. 30, 2022	Sep. 30, 2021
Cash flows from operating activities:
Net income	$ 2,503.1	$ 1,572.0
Adjustments to reconcile net income to net cash provided by operating activities:
Stock-based compensation expense	379.8	322.8
Depreciation expense	109.9	91.8
Decrease in fair value of contingent consideration	(59.3)	(1.1)
Deferred income taxes	(424.0)	(112.7)
Gains (losses) on equity securities	143.1	(5.0)
Other non-cash items, net	(32.8)	20.5
Changes in operating assets and liabilities:
Accounts receivable, net	(368.8)	(231.2)
Inventories	(58.1)	(65.8)
Prepaid expenses and other assets	(41.9)	(107.7)
Accounts payable	(39.1)	(22.0)
Accrued expenses	980.3	254.2
Other liabilities	(40.7)	(67.3)
Net cash provided by operating activities	3,051.5	1,648.5
Cash flows from investing activities:
Purchases of available-for-sale debt securities	(417.8)	(447.8)
Maturities of available-for-sale debt securities	435.9	452.1
Payment to acquire ViaCyte, Inc., net of cash acquired	(295.9)	0.0
Purchases of property and equipment	(171.1)	(173.2)
Investment in equity securities and notes receivable	(47.8)	(38.0)
Net cash used in investing activities	(496.7)	(206.9)
Cash flows from financing activities:
Issuances of common stock under benefit plans	134.7	67.3
Repurchases of common stock	0.0	(1,057.2)
Payments in connection with common stock withheld for employee tax obligations	(169.9)	(134.2)
Payments on finance leases	(75.1)	(34.6)
Proceeds from finance leases	0.0	12.6
Other financing activities	2.4	4.3
Net cash used in financing activities	(107.9)	(1,141.8)
Effect of changes in exchange rates on cash	(70.0)	(8.5)
Net increase in cash, cash equivalents and restricted cash	2,376.9	291.3
Cash, cash equivalents and restricted cash—beginning of period	6,800.1	5,988.9
Cash, cash equivalents and restricted cash—end of period	9,177.0	6,280.2
Supplemental disclosure of cash flow information:
Cash paid for interest	41.1	42.7
Cash paid for income taxes	$ 840.1	$ 381.5