Consolidated Statements of Cash Flows - USD ($) $ in Millions	12 Months Ended
	Dec. 31, 2022	Dec. 31, 2021	Dec. 31, 2020
Cash flows from operating activities:
Net income	$ 3,322.0	$ 2,342.1	$ 2,711.7
Adjustments to reconcile net income to net cash provided by operating activities:
Stock-based compensation expense	491.3	441.4	429.5
Depreciation expense	148.3	125.6	109.5
Deferred income taxes	(275.9)	(154.6)	277.3
Losses (gains) on equity securities	149.1	(17.1)	(311.9)
(Decrease) increase in fair value of contingent consideration	(57.5)	(3.1)	13.1
Other non-cash items, net	11.8	14.4	78.7
Changes in operating assets and liabilities:
Accounts receivable, net	(358.6)	(274.7)	(223.4)
Inventories	(136.4)	(92.8)	(132.0)
Prepaid expenses and other assets	(326.4)	(91.8)	(297.6)
Accounts payable	120.8	31.9	51.3
Accrued expenses	542.5	305.4	122.2
Other liabilities	498.9	16.8	425.1
Net cash provided by operating activities	4,129.9	2,643.5	3,253.5
Cash flows from investing activities:
Payment to acquire ViaCyte, net of cash acquired	(295.9)	0.0	0.0
Purchases of available-for-sale debt securities	(692.7)	(528.2)	(431.4)
Sales and maturities of available-for-sale debt securities	920.0	499.3	372.3
Sale of equity securities	0.0	0.0	437.6
Purchases of property and equipment	(204.7)	(235.0)	(259.8)
Investment in equity securities and notes receivable	(47.8)	(77.0)	(19.3)
Net cash (used in) provided by investing activities	(321.1)	(340.9)	99.4
Cash flows from financing activities:
Issuances of common stock under benefit plans	186.3	102.0	264.9
Repurchases of common stock	0.0	(1,425.4)	(539.1)
Payments in connection with common stock withheld for employee tax obligations	(172.0)	(135.9)	(200.3)
Payments on finance leases	(85.5)	(47.0)	(42.3)
Proceeds from finance leases	0.0	22.6	13.3
Other financing activities	3.5	5.7	(1.8)
Net cash used in financing activities	(67.7)	(1,478.0)	(505.3)
Effect of changes in exchange rates on cash	(29.2)	(13.4)	20.6
Net increase in cash, cash equivalents and restricted cash	3,711.9	811.2	2,868.2
Cash, cash equivalents and restricted cash—beginning of period	6,800.1	5,988.9	3,120.7
Cash, cash equivalents and restricted cash—end of period	10,512.0	6,800.1	5,988.9
Supplemental disclosure of cash flow information:
Cash paid for interest	52.3	56.3	54.5
Cash paid for income taxes	$ 1,057.8	$ 476.3	$ 191.8