Vertex Pharmaceuticals (VRTX) 10-Q 7 Nov 23 2023 Q3 Quarterly report Financial data

Cover

Cover - shares	9 Months Ended
	Sep. 30, 2023	Oct. 31, 2023
Cover [Abstract]
Document Type	10-Q
Document Quarterly Report	true
Document Period End Date	Sep. 30, 2023
Document Transition Report	false
Entity File Number	000-19319
Entity Registrant Name	VERTEX PHARMACEUTICALS INC / MA
Entity Incorporation, State or Country Code	MA
Entity Tax Identification Number	04-3039129
Entity Address, Address Line One	50 Northern Avenue
Entity Address, City or Town	Boston
Entity Address, State or Province	MA
Entity Address, Postal Zip Code	02210
City Area Code	617
Local Phone Number	341-6100
Title of 12(b) Security	Common Stock, $0.01 Par Value Per Share
Trading Symbol	VRTX
Security Exchange Name	NASDAQ
Entity Current Reporting Status	Yes
Entity Interactive Data Current	Yes
Entity Filer Category	Large Accelerated Filer
Entity Small Business	false
Entity Emerging Growth Company	false
Entity Shell Company	false
Entity Common Stock, Shares Outstanding		257,683,184
Entity Central Index Key	0000875320
Current Fiscal Year End Date	--12-31
Document Fiscal Year Focus	2023
Document Fiscal Period Focus	Q3
Amendment Flag	false

Condensed Consolidated Statemen

Condensed Consolidated Statements of Income - USD ($) shares in Millions, $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Income Statement [Abstract]
Product revenues, net	$ 2,483.5	$ 2,334.3	$ 7,351.5	$ 6,628
Costs and expenses:
Cost of sales	318.7	289.4	894.2	797
Research and development expenses	810	645	2,338.3	1,846.2
Acquired in-process research and development expenses	51.7	29	509.3	92.9
Selling, general and administrative expenses	263.8	246.8	767.5	677.3
Change in fair value of contingent consideration	1.2	(2.6)	(1.3)	(59.3)
Total costs and expenses	1,445.4	1,207.6	4,508	3,354.1
Income from operations	1,038.1	1,126.7	2,843.5	3,273.9
Interest income	167.9	46.2	435.2	58.6
Interest expense	(10.9)	(13.7)	(33.5)	(43.2)
Other (expense) income, net	(15.9)	17.2	(13)	(133.7)
Income before provision for income taxes	1,179.2	1,176.4	3,232.2	3,155.6
Provision for income taxes	143.9	245.9	581.4	652.5
Net income	$ 1,035.3	$ 930.5	$ 2,650.8	$ 2,503.1
Net income per common share:
Basic (in dollars per share)	$ 4.01	$ 3.63	$ 10.29	$ 9.78
Diluted (in dollars per share)	$ 3.97	$ 3.59	$ 10.18	$ 9.68
Shares used in per share calculations:
Basic (in shares)	258	256.5	257.7	255.8
Diluted (in shares)	260.6	259.5	260.4	258.7

Condensed Consolidated Statem_2

Condensed Consolidated Statements of Comprehensive Income - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Statement of Comprehensive Income [Abstract]
Net income	$ 1,035.3	$ 930.5	$ 2,650.8	$ 2,503.1
Other comprehensive income (loss):
Unrealized holding losses on marketable securities, net of tax of $1.7, zero, $5.2 and zero, respectively	(6.2)	(0.6)	(18.8)	(3.6)
Unrealized gains on foreign currency forward contracts, net of tax of $(13.2), $(16.0), $(1.6) and $(34.3), respectively	48	58.8	5.9	128.1
Foreign currency translation adjustment	(5)	(18.1)	9.1	(42.8)
Total other comprehensive income (loss)	36.8	40.1	(3.8)	81.7
Comprehensive income	$ 1,072.1	$ 970.6	$ 2,647	$ 2,584.8

Condensed Consolidated Statem_3

Condensed Consolidated Statements of Comprehensive Income (Parenthetical) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Statement of Comprehensive Income [Abstract]
Unrealized holding losses on marketable securities, tax	$ 1.7	$ 0	$ 5.2	$ 0
Unrealized gains (losses) on foreign currency forward contracts, tax	$ (13.2)	$ (16)	$ (1.6)	$ (34.3)

Condensed Consolidated Balance

Condensed Consolidated Balance Sheets - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Current assets:
Cash and cash equivalents	$ 11,110.2	$ 10,504
Marketable securities	818	274.5
Accounts receivable, net	1,538.7	1,442.2
Inventories	688.7	460.6
Prepaid expenses and other current assets	540.2	553.5
Total current assets	14,695.8	13,234.8
Property and equipment, net	1,124	1,108.4
Goodwill	1,088	1,088
Intangible assets	603.6	603.6
Deferred tax assets	1,729.1	1,246.9
Operating lease assets	310.5	347.4
Long-term marketable securities	1,700	112.2
Other assets	475.2	409.6
Total assets	21,726.2	18,150.9
Current liabilities:
Accounts payable	375.9	303.9
Accrued expenses	2,907.3	2,126.7
Other current liabilities	316.2	311.5
Total current liabilities	3,599.4	2,742.1
Long-term finance lease liabilities	390.3	430.8
Long-term operating lease liabilities	354.4	379.5
Other long-term liabilities	869.3	685.8
Total liabilities	5,213.4	4,238.2
Commitments and contingencies	0	0
Shareholders’ equity:
Preferred stock, $0.01 par value; 1,000,000 shares authorized; none issued and outstanding	0	0
Common stock, $0.01 par value; 500,000,000 shares authorized, 257,828,508 and 257,011,628 shares issued and outstanding, respectively	2.6	2.6
Additional paid-in capital	7,339.6	7,386.5
Accumulated other comprehensive (loss) income	(3)	0.8
Retained earnings	9,173.6	6,522.8
Total shareholders’ equity	16,512.8	13,912.7
Total liabilities and shareholders’ equity	$ 21,726.2	$ 18,150.9

Condensed Consolidated Balanc_2

Condensed Consolidated Balance Sheets (Parenthetical) - $ / shares	Sep. 30, 2023	Dec. 31, 2022
Statement of Financial Position [Abstract]
Preferred stock, par value (in dollars per share)	$ 0.01	$ 0.01
Preferred stock, shares authorized (in shares)	1,000,000	1,000,000
Preferred stock, shares issued (in shares)	0	0
Preferred stock, shares outstanding (in shares)	0	0
Common stock, par value (in dollars per share)	$ 0.01	$ 0.01
Common stock, shares authorized (in shares)	500,000,000	500,000,000
Common stock, shares issued (in shares)	257,828,508	257,011,628
Common stock, shares outstanding (in shares)	257,828,508	257,011,628

Condensed Consolidated Statem_4

Condensed Consolidated Statements of Shareholders' Equity - USD ($) $ in Millions	Total	Common Stock	Additional Paid-in Capital	Accumulated Other Comprehensive Income (Loss)	Retained Earnings
Beginning balance (in shares) at Dec. 31, 2021		254,500,000
Beginning balance at Dec. 31, 2021	$ 10,100	$ 2.5	$ 6,880.8	$ 15.9	$ 3,200.8
Increase (Decrease) in Stockholders' Equity
Other comprehensive income (loss), net of tax	81.7			81.7
Net income	2,503.1				2,503.1
Common stock withheld for employee tax obligations (in shares)		(700,000)
Common stock withheld for employee tax obligations	(169.9)	$ 0	(169.9)
Issuance of common stock under benefit plans (in shares)		2,800,000
Issuance of common stock under benefit plans	135.3	$ 0.1	135.2
Stock-based compensation expense	379.4		379.4
Ending balance (in shares) at Sep. 30, 2022		256,600,000
Ending balance at Sep. 30, 2022	13,029.6	$ 2.6	7,225.5	97.6	5,703.9
Beginning balance (in shares) at Jun. 30, 2022		256,000,000
Beginning balance at Jun. 30, 2022	11,933.5	$ 2.6	7,100	57.5	4,773.4
Increase (Decrease) in Stockholders' Equity
Other comprehensive income (loss), net of tax	40.1			40.1
Net income	930.5				930.5
Common stock withheld for employee tax obligations (in shares)		(200,000)
Common stock withheld for employee tax obligations	(48)	$ 0	(48)
Issuance of common stock under benefit plans (in shares)		800,000
Issuance of common stock under benefit plans	38.2	$ 0	38.2
Stock-based compensation expense	135.3		135.3
Ending balance (in shares) at Sep. 30, 2022		256,600,000
Ending balance at Sep. 30, 2022	$ 13,029.6	$ 2.6	7,225.5	97.6	5,703.9
Beginning balance (in shares) at Dec. 31, 2022	257,011,628	257,000,000
Beginning balance at Dec. 31, 2022	$ 13,912.7	$ 2.6	7,386.5	0.8	6,522.8
Increase (Decrease) in Stockholders' Equity
Other comprehensive income (loss), net of tax	(3.8)			(3.8)
Net income	$ 2,650.8				2,650.8
Repurchase of common stock (in shares)	(891,060)	(900,000)
Repurchase of common stock	$ (284.1)	$ 0	(284.1)
Common stock withheld for employee tax obligations (in shares)		(700,000)
Common stock withheld for employee tax obligations	(222.9)	$ 0	(222.9)
Issuance of common stock under benefit plans (in shares)		2,400,000
Issuance of common stock under benefit plans	85.7	$ 0	85.7
Stock-based compensation expense	$ 374.4		374.4
Ending balance (in shares) at Sep. 30, 2023	257,828,508	257,800,000
Ending balance at Sep. 30, 2023	$ 16,512.8	$ 2.6	7,339.6	(3)	9,173.6
Beginning balance (in shares) at Jun. 30, 2023		257,800,000
Beginning balance at Jun. 30, 2023	15,470.2	$ 2.6	7,369.1	(39.8)	8,138.3
Increase (Decrease) in Stockholders' Equity
Other comprehensive income (loss), net of tax	36.8			36.8
Net income	1,035.3				1,035.3
Repurchase of common stock (in shares)		(400,000)
Repurchase of common stock	(123)	$ 0	(123)
Common stock withheld for employee tax obligations (in shares)		(100,000)
Common stock withheld for employee tax obligations	(53.2)	$ 0	(53.2)
Issuance of common stock under benefit plans (in shares)		500,000
Issuance of common stock under benefit plans	15	$ 0	15
Stock-based compensation expense	$ 131.7		131.7
Ending balance (in shares) at Sep. 30, 2023	257,828,508	257,800,000
Ending balance at Sep. 30, 2023	$ 16,512.8	$ 2.6	$ 7,339.6	$ (3)	$ 9,173.6

Condensed Consolidated Statem_5

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)
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)	(417.8)
Sales and maturities of available-for-sale debt securities	621	435.9
Purchases of property and equipment	(142.3)	(171.1)
Sale of equity securities	95.1	0
Investment in equity securities and notes receivable	(31)	(47.8)
Payment to acquire ViaCyte, Inc., net of cash acquired	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
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)
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	6,800.1
Cash, cash equivalents and restricted cash—end of period	11,116.6	9,177
Supplemental disclosure of cash flow information:
Cash paid for income taxes	919.1	840.1
Cash paid for interest	$ 32.6	$ 41.1

Basis of Presentation and Accou

Basis of Presentation and Accounting Policies	9 Months Ended
	Sep. 30, 2023
Accounting Policies [Abstract]
Basis of Presentation and Accounting Policies	Basis of Presentation and Accounting Policies Basis of Presentation The accompanying condensed consolidated financial statements are unaudited and have been prepared by Vertex Pharmaceuticals Incorporated (“Vertex,” “we,” “us” or “our”) in accordance with accounting principles generally accepted in the United States of America (“U.S. GAAP”). The condensed consolidated financial statements reflect the operations of Vertex and our wholly-owned subsidiaries. All material intercompany balances and transactions have been eliminated. We have reclassified certain items from the prior year’s condensed consolidated balance sheet to conform to the current year’s presentation. We operate in one segment, pharmaceuticals. Certain information and footnote disclosures normally included in our Annual Report on Form 10-K for the fiscal year ended December 31, 2022 (the “2022 Annual Report on Form 10-K”) have been condensed or omitted. These interim financial statements, in the opinion of management, reflect all normal recurring adjustments necessary for a fair presentation of the financial position and results of income for the interim periods ended September 30, 2023 and 2022. The results of operations for the interim periods are not necessarily indicative of the results of operations to be expected for the full fiscal year. These interim financial statements should be read in conjunction with the audited financial statements for the year ended December 31, 2022, which are contained in our 2022 Annual Report on Form 10-K. Use of Estimates The preparation of condensed consolidated financial statements in accordance with U.S. GAAP requires us to make certain estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of our condensed consolidated financial statements, and the amounts of revenues and expenses during the reported periods. We base our estimates on historical experience and various other assumptions, including in certain circumstances future projections that we believe to be reasonable under the circumstances. Actual results could differ from those estimates. Changes in estimates are reflected in reported results in the period in which they become known. Recently Adopted and Issued Accounting Standards For a discussion of recently adopted accounting pronouncements please refer to Note A, “Nature of Business and Accounting Policies,” in our 2022 Annual Report on Form 10-K. We do not expect any recently issued accounting standards to have a significant impact on our condensed consolidated financial statements. Summary of Significant Accounting Policies Our significant accounting policies are described in Note A, “Nature of Business and Accounting Policies,” in our 2022 Annual Report on Form 10-K.

Revenue Recognition

Revenue Recognition	9 Months Ended
	Sep. 30, 2023
Revenue from Contract with Customer [Abstract]
Revenue Recognition	Revenue Recognition Disaggregation of Revenue Revenues by Product “Product revenues, net” consisted of the following: Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 (in millions) TRIKAFTA/KAFTRIO $ 2,274.3 $ 2,010.5 $ 6,611.4 $ 5,665.3 KALYDECO 112.8 139.4 363.1 417.1 ORKAMBI 63.0 146.2 281.8 399.9 SYMDEKO/SYMKEVI 33.4 38.2 95.2 145.7 Total product revenues, net $ 2,483.5 $ 2,334.3 $ 7,351.5 $ 6,628.0 Product Revenues by Geographic Location “Product revenues, net” by geographic region, based on the location of the customer, consisted of the following: Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 (in millions) United States $ 1,554.2 $ 1,455.6 $ 4,465.8 $ 4,238.9 Outside of the United States Europe 766.5 730.5 2,373.7 2,018.3 Other 162.8 148.2 512.0 370.8 Total product revenues outside of the United States 929.3 878.7 2,885.7 2,389.1 Total product revenues, net $ 2,483.5 $ 2,334.3 $ 7,351.5 $ 6,628.0 Contract Liabilities We had contract liabilities of $157.1 million and $159.6 million as of September 30, 2023 and December 31, 2022, respectively, related to annual contracts with government-owned and supported customers in international markets that limit the amount of annual reimbursement we can receive. Upon exceeding the annual reimbursement amount, products are provided free of charge, which is a material right. These contracts include upfront payments and fees. We defer a portion of the consideration received for shipments made up to the annual reimbursement limit as a portion of “Other current liabilities.” The deferred amount is recognized as revenue when the free products are shipped. Our product revenue contracts include performance obligations that are one year or less. Our contract liabilities at the end of each fiscal year relate to contracts with annual reimbursement limits in international markets in which the annual period associated with the contract is not the same as our fiscal year. In these markets, we recognize revenues related to performance obligations satisfied in previous years; however, these revenues do not relate to any performance obligations that were satisfied more than 12 months prior to the beginning of the current year.

Acquired In-Process Research an

Acquired In-Process Research and Development and Other Arrangements	9 Months Ended
	Sep. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Acquired In-Process Research and Development and Other Arrangements	Acquired In-Process Research and Development and Other Arrangements We have entered into numerous agreements with third parties to collaborate on research, development and commercialization programs, license technologies, or acquire assets. Our “Acquired in-process research and development expenses” included $51.7 million and $509.3 million for the three and nine months ended September 30, 2023, respectively, and $29.0 million and $92.9 million, for the three and nine months ended September 30, 2022, respectively, related to upfront, contingent milestone, or other payments pursuant to our business development transactions, including collaborations, licenses of third-party technologies, and asset acquisitions that qualify as in-process research and development. Our collaboration, licensing and asset acquisition agreements that had a significant impact on our financial statements for the three and nine months ended September 30, 2023 and 2022, or were new or materially revised during the three and nine months ended September 30, 2023, are described below. Additional agreements were described in Note B, “Acquired In-Process Research and Development and Other Arrangements,” of our 2022 Annual Report on Form 10-K. In-license Agreements We have entered into several in-license agreements to advance and obtain access to technologies and services related to our research and early-development activities. We are generally required to make an upfront payment upon execution of our license agreements; development, regulatory and commercialization milestones payments upon the achievement of certain product research, development and commercialization objectives; and royalty payments on future sales, if any, of commercial products resulting from our collaborations. Pursuant to the terms of our in-license agreements, our collaborators typically lead the discovery efforts and we lead all preclinical, development and commercialization activities associated with the advancement of any product candidates and fund all expenses. We typically can terminate our in-license agreements by providing advance notice to our collaborators. Our license agreements may be terminated by either party for a material breach by the other, subject to notice and cure provisions. Unless earlier terminated, these license agreements generally remain in effect until the date on which the royalty term and all payment obligations with respect to all products in all countries have expired. CRISPR Therapeutics AG CRISPR-Cas9 Gene-editing Therapies Agreements In 2015, we entered into a strategic collaboration, option, and license agreement (the “CRISPR Agreement”) with CRISPR Therapeutics AG and its affiliates (“CRISPR”) to collaborate on the discovery and development of potential new treatments aimed at the underlying genetic causes of human diseases using CRISPR-Cas9 gene-editing technology. We had the exclusive right to license certain targets. In 2019, we elected to exclusively license three targets, including cystic fibrosis, pursuant to the CRISPR Agreement. For each of the three targets that we elected to license, CRISPR has the potential to receive up to an additional $410.0 million in development, regulatory and commercial milestones as well as royalties on resulting net product sales. In 2017, we entered into a joint development and commercialization agreement with CRISPR (the “CRISPR JDCA”), which we amended and restated in 2021, pursuant to the terms of the CRISPR Agreement. Under the CRISPR JDCA, we and CRISPR are co-developing and preparing to co-commercialize exagamglogene autotemcel (“exa-cel”), for the treatment of hemoglobinopathies, including treatments for sickle cell disease and transfusion-dependent beta thalassemia. Pursuant to the CRISPR JDCA, we lead global development, manufacturing, and commercialization of exa-cel, with support from CRISPR. We also conduct all research, development, manufacturing, and commercialization activities relating to other product candidates and products under the CRISPR JDCA throughout the world subject to CRISPR’s reserved right to conduct certain activities. In connection with the CRISPR JDCA, CRISPR has the potential to receive a one-time $200.0 million milestone payment upon receipt of the first marketing approval of exa-cel from the U.S. Food and Drug Administration or the European Commission. We account for the CRISPR JDCA as a cost-sharing arrangement, with costs incurred related to exa-cel allocated 60% to us and 40% to CRISPR, subject to certain adjustments. We recognized the net impact of the CRISPR JDCA as “Research and development expenses” of $74.9 million and $45.5 million during the three months ended September 30, 2023 and 2022, respectively, and $193.2 million and $120.6 million during the nine months ended September 30, 2023 and 2022, respectively; and as “Selling, general and administrative expenses” of $26.0 million and $13.5 million during the three months ended September 30, 2023 and 2022, respectively, and $66.1 million and $35.3 million during the nine months ended September 30, 2023 and 2022, respectively. In March 2023, we entered into a non-exclusive license agreement (“the CRISPR T1D Agreement”) for the use of CRISPR’s CRISPR-Cas9 gene-editing technology to accelerate the development of our hypoimmune cell therapies for type 1 diabetes. Pursuant to the CRISPR T1D Agreement, we made a $100.0 million upfront payment to CRISPR. In the second quarter of 2023, we achieved a research milestone that resulted in a $70.0 million payment to CRISPR in the third quarter of 2023. CRISPR is eligible to receive up to an additional $160.0 million in research, development, regulatory and commercial milestones for any products that may result from the agreement, as well as royalties on resulting net product sales. We determined that substantially all the fair value of the collaboration agreement was attributable to in-process research and development and no substantive processes were acquired that would constitute a business. We concluded that there is no alternative future use for the acquired in-process research and development and recorded the upfront payment and the research milestone to “Acquired in-process research and development expenses” in the first and second quarters of 2023, respectively, resulting in $170.0 million of “Acquired in-process research and development expenses” in the nine months ended September 30, 2023. Entrada Therapeutics, Inc. In February 2023, we closed a strategic collaboration and license agreement (the “Entrada Agreement”) with Entrada Therapeutics, Inc. (“Entrada”) focused on discovering and developing intracellular Endosomal Escape Vehicle (EEV) therapeutics for myotonic dystrophy type 1 (“DM1”). Upon closing, we made an upfront payment of $225.1 million to Entrada, and purchased $24.9 million of Entrada’s common stock in connection with the Entrada Agreement. Entrada is eligible to receive up to an additional $485.0 million in research, development, regulatory and commercial milestones for any products that may result from the Entrada Agreement, as well as royalties on resulting net product sales. We determined that substantially all the fair value of the collaboration agreement was attributable to in-process research and development and no substantive processes were acquired that would constitute a business. We concluded that there is no alternative future use for the acquired in-process research and development and recorded the upfront payment to “Acquired in-process research and development expenses” in the first quarter of 2023. The investment in Entrada’s common stock is recorded at fair value on our condensed consolidated balance sheet within “Marketable securities.” Verve Therapeutics, Inc. In July 2022, we entered into a research collaboration with Verve Therapeutics, Inc. (“Verve”) focused on discovering and developing an in vivo gene-editing program for a liver disease. Under the terms of the agreement, we made a $25.0 million upfront payment to Verve and purchased $35.0 million of Verve’s common stock. We concluded that there is no alternative future use for the acquired in-process research and development and recorded the upfront payment to “Acquired in-process research and development expenses.” The investment in Verve’s common stock is recorded at fair value on our condensed consolidated balance sheet within “Marketable securities.” Asset Acquisitions Septerna, Inc. - Novel G Protein-coupled Receptor Program In September 2023, pursuant to an asset purchase agreement, we acquired a novel G protein-coupled receptor (“GPCR”) program from Septerna, Inc. We determined that substantially all the fair value acquired is concentrated in the GPCR in-process research and development asset, which does not constitute a business, and for which we determined there is no alternative future use. As a result, we recorded $47.5 million to “Acquired in-process research and development expenses” in the three and nine months ended September 30, 2023. Catalyst Biosciences, Inc. - Complement 3 Degrader Program In May 2022, pursuant to an asset purchase agreement, we acquired Catalyst Biosciences, Inc.’s portfolio of protease medicines that target the complement system (the “complement portfolio”) and related intellectual property, including CB 2782-PEG, which is a pre-clinical complement component 3 degrader program for geographic atrophy in dry age-related macular degeneration. We determined that substantially all the fair value acquired is concentrated in the CB-2782 PEG in- process research and development assets, which do not constitute a business, and for which we determined there is no alternative future use. As a result, we recorded our $60.0 million upfront payment to “Acquired in-process research and development expenses” in the three and nine months ended September 30, 2022. Cystic Fibrosis Foundation In 2004, we entered into a collaboration agreement with the Cystic Fibrosis Foundation, as successor in interest to the Cystic Fibrosis Foundation Therapeutics, Inc., to support research and development activities. Pursuant to the collaboration agreement, as amended, we have agreed to pay tiered royalties ranging from single digits to sub-teens on covered compounds first synthesized and/or tested during a research term on or before February 28, 2014, including ivacaftor, lumacaftor and tezacaftor and royalties ranging from low-single digits to mid-single digits on potential net sales of certain compounds first synthesized and/or tested between March 1, 2014 and August 31, 2016, including elexacaftor. We do not have any royalty obligations on compounds first synthesized and tested on or after September 1, 2016. For combination products, such as ORKAMBI, SYMDEKO/SYMKEVI and TRIKAFTA/KAFTRIO, sales are allocated equally to each of the active pharmaceutical ingredients in the combination product. We record expenses related to these royalty obligations to “Cost of sales.”

Earnings Per Share

Earnings Per Share	9 Months Ended
	Sep. 30, 2023
Earnings Per Share [Abstract]
Earnings Per Share	Earnings Per Share The following table sets forth the computation of basic and diluted net income per common share for the periods ended: Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 (in millions, except per share amounts) Net income $ 1,035.3 $ 930.5 $ 2,650.8 $ 2,503.1 Basic weighted-average common shares outstanding 258.0 256.5 257.7 255.8 Effect of potentially dilutive securities: Stock options 1.2 1.4 1.2 1.4 Restricted stock units (including PSUs) 1.4 1.6 1.5 1.4 Employee stock purchase program 0.0 0.0 0.0 0.1 Diluted weighted-average common shares outstanding 260.6 259.5 260.4 258.7 Basic net income per common share $ 4.01 $ 3.63 $ 10.29 $ 9.78 Diluted net income per common share $ 3.97 $ 3.59 $ 10.18 $ 9.68 We did not include the securities in the following table in the computation of the diluted net income per common share because the effect would have been anti-dilutive during each period: Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 (in millions) Stock options — — 0.0 0.0 Unvested restricted stock units (including PSUs) — 0.0 0.2 0.2

Fair Value Measurements

Fair Value Measurements	9 Months Ended
	Sep. 30, 2023
Fair Value Disclosures [Abstract]
Fair Value Measurements	Fair Value Measurements The following fair value hierarchy is used to classify assets and liabilities based on observable inputs and unobservable inputs used in order to determine the fair value of our financial assets and liabilities: Level 1: Quoted prices in active markets for identical assets or liabilities. An active market for an asset or liability is a market in which transactions for the asset or liability occur with sufficient frequency and volume to provide pricing information on an ongoing basis. Level 2: Observable inputs other than Level 1 inputs. Examples of Level 2 inputs include quoted prices in active markets for similar assets or liabilities and quoted prices for identical assets or liabilities in markets that are not active. Level 3: Unobservable inputs based on our assessment of the assumptions that market participants would use in pricing the asset or liability. Our investment strategy is focused on capital preservation. We invest in instruments that meet the credit quality standards outlined in our investment policy, which also limits the amount of credit exposure to any one issue or type of instrument. We maintain strategic equity investments separately from the investment policy that governs our other cash, cash equivalents and marketable securities as described in Note F, “Marketable Securities and Equity Investments.” Additionally, we utilize foreign currency forward contracts intended to mitigate the effect of changes in foreign exchange rates on our condensed consolidated statement of income. The following tables set forth our financial assets and liabilities subject to fair value measurements by level within the fair value hierarchy (and does not include $5.5 billion and $3.1 billion of cash as of September 30, 2023 and December 31, 2022, respectively): As of September 30, 2023 As of December 31, 2022 Total Level 1 Level 2 Level 3 Total Level 1 Level 2 Level 3 (in millions) Financial instruments carried at fair value (asset positions): Cash equivalents: Money market funds $ 3,753.4 $ 3,753.4 $ — $ — $ 5,162.6 $ 5,162.6 $ — $ — Time deposits 1,550.0 — 1,550.0 — 2,000.0 — 2,000.0 — U.S. Treasury securities 236.8 236.8 — — — — — — Corporate debt securities — — — — 5.8 — 5.8 — Commercial paper 96.5 — 96.5 — 204.5 — 204.5 — Marketable securities: Corporate equity securities 46.4 46.4 — — 116.8 88.8 28.0 — U.S. Treasury securities 408.2 408.2 — — — — — — Government-sponsored enterprise securities 421.0 421.0 — — 127.1 127.1 — — Asset-backed securities 237.8 — 237.8 — — — — — Certificates of deposit 31.7 — 31.7 — — — — — Corporate debt securities 1,214.2 — 1,214.2 — 87.0 — 87.0 — Commercial paper 158.7 — 158.7 — 55.8 — 55.8 — Prepaid expenses and other current assets: Foreign currency forward contracts 37.8 — 37.8 — 47.5 — 47.5 — Other assets: Foreign currency forward contracts 3.4 — 3.4 — 0.8 — 0.8 — Total financial assets $ 8,195.9 $ 4,865.8 $ 3,330.1 $ — $ 7,807.9 $ 5,378.5 $ 2,429.4 $ — Financial instruments carried at fair value (liability positions): Other current liabilities: Foreign currency forward contracts $ (0.7) $ — $ (0.7) $ — $ (14.3) $ — $ (14.3) $ — Contingent consideration (15.0) — — (15.0) (14.6) — — (14.6) Other long-term liabilities: Foreign currency forward contracts — — — — (0.9) — (0.9) — Contingent consideration (112.7) — — (112.7) (114.4) — — (114.4) Total financial liabilities $ (128.4) $ — $ (0.7) $ (127.7) $ (144.2) $ — $ (15.2) $ (129.0) Please refer to Note F, “Marketable Securities and Equity Investments,” for the carrying amount and related unrealized gains (losses) by type of investment. Fair Value of Corporate Equity Securities We classify our investments in publicly traded corporate equity securities as “Marketable securities” on our condensed consolidated balance sheets. Generally, our investments in the common stock of publicly traded companies are valued based on Level 1 inputs because they have readily determinable fair values. However, certain of our investments in publicly traded companies have been or continue to be valued based on Level 2 inputs due to transfer restrictions associated with these investments. As of September 30, 2023, one of our investments in publicly traded corporate equity securities was subject to a contractual sales restriction expiring partially in 2024 and partially in 2025 with a total fair value of $25.5 million. We purchased this investment directly from the publicly traded company in the first quarter of 2023, and do not anticipate any circumstances that would cause this restriction to lapse prior to the periods listed above. Please refer to Note F, “Marketable Securities and Equity Investments,” for further information on these investments. Fair Value of Contingent Consideration In 2019, we acquired Exonics Therapeutics, Inc. (“Exonics”), a privately-held company focused on creating transformative gene-editing therapies to repair mutations that cause Duchenne muscular dystrophy (“DMD”) and other severe neuromuscular diseases, including DM1. Our Level 3 contingent consideration liabilities are related to $678.3 million of development and regulatory milestones potentially payable to former Exonics equity holders. We base our estimates of the probability of achieving the milestones relevant to the fair value of contingent payments, which could include milestone, royalty and option payments, on industry data attributable to rare diseases and our knowledge of the progress and viability of the programs. The discount rates used in the valuation model for contingent payments, which were between 5.5% and 6.5% as of September 30, 2023, represent a measure of credit risk and market risk associated with settling the liabilities. Significant judgment is used in determining the appropriateness of these assumptions at each reporting period. The following table represents a rollforward of the fair value of our contingent consideration liabilities: Nine Months Ended September 30, 2023 (in millions) Balance at December 31, 2022 $ 129.0 Decrease in fair value of contingent payments (1.3) Balance at September 30, 2023 $ 127.7 In November 2023, we determined that additional pre-clinical studies of the delivery system for our gene-editing components for DMD will be required. Any potential impact on the fair value of our contingent consideration liabilities will be recognized as of December 31, 2023.

Marketable Securities and Equit

Marketable Securities and Equity Investments	9 Months Ended
	Sep. 30, 2023
Investments, Debt and Equity Securities [Abstract]
Marketable Securities and Equity Investments	Marketable Securities and Equity Investments A summary of our cash equivalents and marketable securities, which are recorded at fair value (and do not include $5.5 billion and $3.1 billion of cash as of September 30, 2023 and December 31, 2022, respectively), is shown below: As of September 30, 2023 As of December 31, 2022 Amortized Cost Gross Gross Fair Value Amortized Cost Gross Gross Fair Value (in millions) Cash equivalents: Money market funds $ 3,753.4 $ — $ — $ 3,753.4 $ 5,162.6 $ — $ — $ 5,162.6 Time deposits 1,550.0 — — 1,550.0 2,000.0 — — 2,000.0 U.S. Treasury securities 236.8 — — 236.8 — — — — Corporate debt securities — — — — 5.8 — — 5.8 Commercial paper 96.5 — — 96.5 204.5 — — 204.5 Total cash equivalents $ 5,636.7 $ — $ — $ 5,636.7 $ 7,372.9 $ — $ — $ 7,372.9 Marketable securities: U.S. Treasury securities $ 414.6 $ 0.1 $ (6.5) $ 408.2 $ — $ — $ — $ — Government-sponsored enterprise securities 422.9 — (1.9) 421.0 127.0 0.2 (0.1) 127.1 Asset-backed securities 239.3 0.0 (1.5) 237.8 — — — — Certificates of deposit 31.7 0.0 — 31.7 — — — — Corporate debt securities 1,228.4 0.0 (14.2) 1,214.2 87.2 — (0.2) 87.0 Commercial paper 158.8 0.0 (0.1) 158.7 55.8 — — 55.8 Total marketable debt securities 2,495.7 0.1 (24.2) 2,471.6 270.0 0.2 (0.3) 269.9 Corporate equity securities 72.1 0.5 (26.2) 46.4 104.4 30.9 (18.5) 116.8 Total marketable securities $ 2,567.8 $ 0.6 $ (50.4) $ 2,518.0 $ 374.4 $ 31.1 $ (18.8) $ 386.7 Available-for-sale debt securities were classified on our condensed consolidated balance sheets at fair value as follows: As of September 30, 2023 As of December 31, 2022 (in millions) Cash and cash equivalents $ 4,086.7 $ 5,372.9 Marketable securities 771.6 157.7 Long-term marketable securities 1,700.0 112.2 Total $ 6,558.3 $ 5,642.8 Available-for-sale debt securities by contractual maturity were as follows: As of September 30, 2023 As of December 31, 2022 (in millions) Matures within one year $ 4,858.3 $ 5,530.6 Matures after one year through five years 1,700.0 112.2 Total $ 6,558.3 $ 5,642.8 We did not record any allowances for credit losses to adjust the fair value of available-for-sale debt securities or gross realized gains or losses in the three and nine months ended September 30, 2023 and 2022. As of September 30, 2023, we held available-for-sale debt securities with a total fair value of $2.28 billion that were in unrealized loss positions totaling $24.2 million; however, none of these investments had been in an unrealized loss position for greater than twelve months. We record changes in the fair value of our investments in corporate equity securities to “Other (expense) income, net” in our condensed consolidated statements of income. During the three and nine months ended September 30, 2023 and 2022, our net unrealized (losses) gains on corporate equity securities held at the conclusion of each period were as follows: Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 (in millions) Net unrealized (losses) gains $ (6.2) $ 16.7 $ (7.1) $ (143.1) During the nine months ended September 30, 2023, we received proceeds of $95.1 million related to the sale of the common stock of a publicly traded company, which had a total original cost basis of $57.3 million. There were no sales of the common stock of publicly traded companies during the nine months ended September 30, 2022. As of September 30, 2023, the carrying value of our equity investments without readily determinable fair values, which are recorded in “Other assets” on our condensed consolidated balance sheets, was $98.6 million.

Accumulated Other Comprehensive

Accumulated Other Comprehensive Income (Loss)	9 Months Ended
	Sep. 30, 2023
Equity [Abstract]
Accumulated Other Comprehensive Income (Loss)	Accumulated Other Comprehensive Income (Loss) The following table summarizes the changes in accumulated other comprehensive income (loss) by component: Unrealized Holding Gains (Losses), Net of Tax Foreign Currency Translation Adjustment On Available-For-Sale Debt Securities On Foreign Currency Forward Contracts Total (in millions) Balance at December 31, 2022 $ (25.0) $ (0.1) $ 25.9 $ 0.8 Other comprehensive income (loss) before reclassifications 9.1 (18.8) 31.8 22.1 Amounts reclassified from accumulated other comprehensive income (loss) — — (25.9) (25.9) Net current period other comprehensive income (loss) 9.1 (18.8) 5.9 (3.8) Balance at September 30, 2023 $ (15.9) $ (18.9) $ 31.8 $ (3.0) Balance at December 31, 2021 $ (13.6) $ (0.5) $ 30.0 $ 15.9 Other comprehensive (loss) income before reclassifications (42.8) (3.6) 230.2 183.8 Amounts reclassified from accumulated other comprehensive income (loss) — — (102.1) (102.1) Net current period other comprehensive (loss) income (42.8) (3.6) 128.1 81.7 Balance at September 30, 2022 $ (56.4) $ (4.1) $ 158.1 $ 97.6

Hedging

Hedging	9 Months Ended
	Sep. 30, 2023
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Hedging	Hedging Foreign currency forward contracts - Designated as hedging instruments We maintain a hedging program intended to mitigate the effect of changes in foreign exchange rates for a portion of our forecasted product revenues denominated in certain foreign currencies. The program includes foreign currency forward contracts that are designated as cash flow hedges under U.S. GAAP having contractual durations from one condensed consolidated statements of income in the same period that we recognize the product revenues that were impacted by the hedged foreign exchange rate changes. We formally document the relationship between foreign currency forward contracts (hedging instruments) and forecasted product revenues (hedged items), as well as our risk management objective and strategy for undertaking various hedging activities, which includes matching all foreign currency forward contracts that are designated as cash flow hedges to forecasted transactions. We also formally assess, both at the hedge’s inception and on an ongoing basis, whether the foreign currency forward contracts are highly effective in offsetting changes in cash flows of hedged items on a prospective and retrospective basis. If we were to determine that a (i) foreign currency forward contract is not highly effective as a cash flow hedge, (ii) foreign currency forward contract has ceased to be a highly effective hedge or (iii) forecasted transaction is no longer probable of occurring, we would discontinue hedge accounting treatment prospectively. We measure effectiveness based on the change in fair value of the forward contracts and the fair value of the hypothetical foreign currency forward contracts with terms that match the critical terms of the risk being hedged. As of September 30, 2023, all hedges were determined to be highly effective. We consider the impact of our counterparties’ credit risk on the fair value of the foreign currency forward contracts. As of September 30, 2023 and December 31, 2022, credit risk did not change the fair value of our foreign currency forward contracts. The following table summarizes the notional amount in U.S. dollars of our outstanding foreign currency forward contracts designated as cash flow hedges under U.S. GAAP: As of September 30, 2023 As of December 31, 2022 Foreign Currency (in millions) Euro $ 1,343.3 $ 1,497.7 Canadian dollar 192.6 216.3 British pound sterling 191.9 247.4 Australian dollar 136.2 174.9 Swiss Franc 51.7 65.2 Total foreign currency forward contracts $ 1,915.7 $ 2,201.5 Foreign currency forward contracts - Not designated as hedging instruments We also enter into foreign currency forward contracts with contractual maturities of less than one month, which are designed to mitigate the effect of changes in foreign exchange rates on monetary assets and liabilities, including intercompany balances. These contracts are not designated as hedging instruments under U.S. GAAP. We recognize realized gains and losses for such contracts in “Other (expense) income, net” in our condensed consolidated statements of income each period. As of September 30, 2023, the notional amount of our outstanding foreign currency forward contracts where hedge accounting under U.S. GAAP is not applied was $922.8 million. During the three and nine months ended September 30, 2023 and 2022, we recognized the following related to foreign currency forward contracts in our condensed consolidated statements of income: Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 (in millions) Designated as hedging instruments - Reclassified from AOCI Product revenues, net $ 2.8 $ 65.2 $ 33.0 $ 130.3 Not designated as hedging instruments Other (expense) income, net $ (22.0) $ (22.1) $ (17.8) $ (38.9) Total reported in the Condensed Consolidated Statements of Income Product revenues, net $ 2,483.5 $ 2,334.3 $ 7,351.5 $ 6,628.0 Other (expense) income, net $ (15.9) $ 17.2 $ (13.0) $ (133.7) The following table summarizes the fair value of our outstanding foreign currency forward contracts designated as cash flow hedges under U.S. GAAP included on our condensed consolidated balance sheets: As of September 30, 2023 Assets Liabilities Classification Fair Value Classification Fair Value (in millions) Prepaid expenses and other current assets $ 37.8 Other current liabilities $ (0.7) Other assets 3.4 Other long-term liabilities — Total assets $ 41.2 Total liabilities $ (0.7) As of December 31, 2022 Assets Liabilities Classification Fair Value Classification Fair Value (in millions) Prepaid expenses and other current assets $ 47.5 Other current liabilities $ (14.3) Other assets 0.8 Other long-term liabilities (0.9) Total assets $ 48.3 Total liabilities $ (15.2) As of September 30, 2023, we expect the amounts that are related to foreign exchange forward contracts designated as cash flow hedges under U.S. GAAP recorded in “Prepaid expenses and other current assets” and “Other current liabilities” to be reclassified to earnings within twelve months. We present the fair value of our foreign currency forward contracts on a gross basis within our condensed consolidated balance sheets. The following table summarizes the potential effect of offsetting derivatives by type of financial instrument designated as cash flow hedges under U.S. GAAP on our condensed consolidated balance sheets: As of September 30, 2023 Gross Amounts Recognized Gross Amounts Offset Gross Amounts Presented Gross Amounts Not Offset Legal Offset Foreign currency forward contracts (in millions) Total assets $ 41.2 $ — $ 41.2 $ (0.7) $ 40.5 Total liabilities (0.7) — (0.7) 0.7 — As of December 31, 2022 Gross Amounts Recognized Gross Amounts Offset Gross Amounts Presented Gross Amounts Not Offset Legal Offset Foreign currency forward contracts (in millions) Total assets $ 48.3 $ — $ 48.3 $ (15.2) $ 33.1 Total liabilities (15.2) — (15.2) 15.2 —

Inventories

Inventories	9 Months Ended
	Sep. 30, 2023
Inventory Disclosure [Abstract]
Inventories	Inventories Inventories consisted of the following: As of September 30, 2023 As of December 31, 2022 (in millions) Raw materials $ 77.5 $ 38.1 Work-in-process 498.3 260.7 Finished goods 112.9 161.8 Total $ 688.7 $ 460.6

Stock-based Compensation Expens

Stock-based Compensation Expense and Share Repurchase Programs	9 Months Ended
	Sep. 30, 2023
Share-Based Payment Arrangement [Abstract]
Stock-based Compensation Expense and Share Repurchase Programs	Stock-based Compensation Expense and Share Repurchase Programs Stock-based compensation expense During the three and nine months ended September 30, 2023 and 2022, we recognized the following stock-based compensation expense: Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 (in millions) Stock-based compensation expense by type of award: Restricted stock units (including PSUs) $ 129.1 $ 130.3 $ 358.6 $ 351.5 Stock options 0.2 3.1 4.0 14.9 ESPP share issuances 2.4 1.9 11.8 13.0 Stock-based compensation expense related to inventories (0.8) 0.3 (1.8) 0.4 Total stock-based compensation expense included in “Total costs and expenses” $ 130.9 $ 135.6 $ 372.6 $ 379.8 Stock-based compensation expense by line item: Cost of sales $ 1.7 $ 2.4 $ 5.4 $ 7.0 Research and development expenses 81.1 80.0 231.9 229.9 Selling, general and administrative expenses 48.1 53.2 135.3 142.9 Total stock-based compensation expense included in costs and expenses 130.9 135.6 372.6 379.8 Income tax effect (37.1) (38.8) (109.0) (101.3) Total stock-based compensation expense, net of tax $ 93.8 $ 96.8 $ 263.6 $ 278.5 Share repurchase program In February 2023, our Board of Directors approved a share repurchase program (our “Share Repurchase Program”), pursuant to which we are authorized to repurchase up to $3.0 billion of our common stock. Our Share Repurchase Program does not have an expiration date and can be discontinued at any time. During the nine months ended September 30, 2023, we repurchased 891,060 shares of our common stock under our Share Repurchase Program for an aggregate of $284.1 million. As of September 30, 2023, a total of $2.7 billion remained authorized for future repurchases.

Income Taxes

Income Taxes	9 Months Ended
	Sep. 30, 2023
Income Tax Disclosure [Abstract]
Income Taxes	Income Taxes We are subject to U.S. federal, state, and foreign income taxes. During the three and nine months ended September 30, 2023 and 2022, we recorded the following provisions for income taxes and effective tax rates as compared to our income before provision for income taxes: Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 (in millions, except percentages) Income before provision for income taxes $ 1,179.2 $ 1,176.4 $ 3,232.2 $ 3,155.6 Provision for income taxes $ 143.9 $ 245.9 $ 581.4 $ 652.5 Effective tax rate 12.2 % 20.9 % 18.0 % 20.7 % Our effective tax rate for each of the three and nine months ended September 30, 2023 was lower than the U.S. statutory rate primarily due to a benefit from a research and development tax credit study that was completed in the third quarter of 2023 and excess tax benefits related to stock-based compensation, partially offset by changes in uncertain tax positions. Our effective tax rate was similar to the U.S. statutory rate for each of the three and nine months ended September 30, 2022. We have reviewed the tax positions taken, or to be taken, in our tax returns for all tax years currently open to examination by a taxing authority. As of September 30, 2023 and December 31, 2022, we had $245.4 million and $208.5 million, respectively, of net unrecognized tax benefits, which would affect our tax rate if recognized.

Commitments and Contingencies

Commitments and Contingencies	9 Months Ended
	Sep. 30, 2023
Commitments and Contingencies Disclosure [Abstract]
Commitments and Contingencies	Commitments and Contingencies 2022 Credit Facility In July 2022, Vertex and certain of its subsidiaries entered into a $500.0 million unsecured revolving facility (the “Credit Agreement”) with Bank of America, N.A., as administrative agent and the lenders referred to therein (the “Lenders”), which matures on July 1, 2027. The Credit Agreement was not drawn upon at closing and we have not drawn upon it to date. Amounts drawn pursuant to the Credit Agreement, if any, will be used for general corporate purposes. Subject to satisfaction of certain conditions, we may request that the borrowing capacity for the Credit Agreement be increased by an additional $500.0 million. Additionally, the Credit Agreement provides a sublimit of $100.0 million for letters of credit. Any amounts borrowed under the Credit Agreement will bear interest, at our option, at either a base rate or a Secured Overnight Financing Rate (“SOFR”), in each case plus an applicable margin. Under the Credit Agreement, the applicable margins on base rate loans range from 0.000% to 0.500% and the applicable margins on SOFR loans range from 1.000% to 1.500%, in each case based on our consolidated leverage ratio (the ratio of our total consolidated funded indebtedness to our consolidated EBITDA for the most recently completed four fiscal quarter period). Any amounts borrowed pursuant to the Credit Agreement are guaranteed by certain of our existing and future domestic subsidiaries, subject to certain exceptions. The Credit Agreement contains customary representations and warranties and affirmative and negative covenants, including a financial covenant to maintain subject to certain limited exceptions, a consolidated leverage ratio of 3.50 to 1.00, subject to an increase to 4.00 to 1.00 following a material acquisition. As of September 30, 2023, we were in compliance with the covenants described above. The Credit Agreement also contains customary events of default. In the case of a continuing event of default, the administrative agent would be entitled to exercise various remedies, including the acceleration of amounts due under outstanding loans. Direct costs related to the Credit Agreement are recorded over its term and were not material to our financial statements. Guaranties and Indemnifications As permitted under Massachusetts law, our Articles of Organization and By-laws provide that we will indemnify certain of our officers and directors for certain claims asserted against them in connection with their service as an officer or director. The maximum potential amount of future payments that we could be required to make under these indemnification provisions is unlimited. However, we have purchased directors’ and officers’ liability insurance policies that could reduce our monetary exposure and enable us to recover a portion of any future amounts paid. No indemnification claims currently are outstanding, and we believe the estimated fair value of these indemnification arrangements is minimal. We customarily agree in the ordinary course of our business to indemnification provisions in agreements with clinical trial investigators and sites in our product development programs, sponsored research agreements with academic and not-for-profit institutions, various comparable agreements involving parties performing services for us, and our real estate leases. We also customarily agree to certain indemnification provisions in our drug discovery, development and commercialization collaboration agreements. With respect to our clinical trials and sponsored research agreements, these indemnification provisions typically apply to any claim asserted against the investigator or the investigator’s institution relating to personal injury or property damage, violations of law or certain breaches of our contractual obligations arising out of the research or clinical testing of our compounds or product candidates. With respect to lease agreements, the indemnification provisions typically apply to claims asserted against the landlord relating to personal injury or property damage caused by us, to violations of law by us or to certain breaches of our contractual obligations. The indemnification provisions appearing in our collaboration agreements are similar to those for the other agreements discussed above, but in addition provide some limited indemnification for our collaborator in the event of third-party claims alleging infringement of intellectual property rights. In each of the cases above, the indemnification obligation generally survives the termination of the agreement for some extended period, although we believe the obligation typically has the most relevance during the contract term and for a short period of time thereafter. The maximum potential amount of future payments that we could be required to make under these provisions is generally unlimited. We have purchased insurance policies covering personal injury, property damage and general liability that reduce our exposure for indemnification and would enable us in many cases to recover all or a portion of any future amounts paid. We have never paid any material amounts to defend lawsuits or settle claims related to these indemnification provisions. Accordingly, we believe the estimated fair value of these indemnification arrangements is minimal. Other Contingencies We have certain contingent liabilities that arise in the ordinary course of our business activities. We accrue for such contingent liabilities when it is probable that future expenditures will be made, and such expenditures can be reasonably estimated. Other than our contingent consideration liabilities discussed in Note E, “Fair Value Measurements,” there were no material contingent liabilities accrued as of September 30, 2023 or December 31, 2022.

Additional Cash Flow Informatio

Additional Cash Flow Information	9 Months Ended
	Sep. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Additional Cash Flow Information	Additional Cash Flow Information The cash, cash equivalents and restricted cash at the beginning and ending of each period presented in our condensed consolidated statements of cash flows consisted of the following: Nine Months Ended September 30, 2023 2022 Beginning of period End of period Beginning of period End of period (in millions) Cash and cash equivalents $ 10,504.0 $ 11,110.2 $ 6,795.0 $ 9,171.5 Prepaid expenses and other current assets 8.0 6.4 5.1 5.5 Cash, cash equivalents and restricted cash per condensed consolidated statement of cash flows $ 10,512.0 $ 11,116.6 $ 6,800.1 $ 9,177.0

Pay vs Performance Disclosure

Pay vs Performance Disclosure - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Pay vs Performance Disclosure
Net income	$ 1,035.3	$ 930.5	$ 2,650.8	$ 2,503.1

Insider Trading Arrangements

Insider Trading Arrangements	3 Months Ended	9 Months Ended
	Sep. 30, 2023 shares	Sep. 30, 2023 shares
Trading Arrangements, by Individual
Material Terms of Trading Arrangement		The following table describes the written plans for the sale of our securities adopted by our executive officers and directors during the third quarter of 2023, each of which is intended to satisfy the affirmative defense conditions of Rule 10b5-1 (each, a “Trading Plan”). Name and Title Date of Adoption of Trading Plan Scheduled Expiration Date of Trading Plan (1) Maximum Shares Subject to Trading Plan E. Morrow “Morrey” Atkinson III EVP, Chief Technical Operations Officer, Head of Biopharmaceutical Sciences and Manufacturing Operations 8/22/2023 4/30/2024 9,224 (2) Reshma Kewalramani President, Chief Executive Officer and Director 8/11/2023 8/15/2024 27,330 Jeffrey M. Leiden Executive Chairman 8/4/2023 5/15/2025 40,454 (2) Bastiano Sanna EVP, Chief of Cell and Genetic Therapies 8/25/2023 8/9/2024 32,833 (2) Charles F. Wagner, Jr. EVP, Chief Financial Officer 8/18/2023 8/9/2024 6,000 (1) A Trading Plan may expire on an earlier date if all contemplated transactions are completed before such Trading Plan’s expiration date, upon termination by broker or the holder of the Trading Plan, or as otherwise provided in the Trading Plan.
Non-Rule 10b5-1 Arrangement Adopted	false
Rule 10b5-1 Arrangement Terminated	false
Non-Rule 10b5-1 Arrangement Terminated	false
E. Morrow "Morrey" Atkinson III [Member]
Trading Arrangements, by Individual
Name	E. Morrow “Morrey” Atkinson III
Title	EVP, Chief Technical Operations Officer, Head of Biopharmaceutical Sciences and Manufacturing Operations
Rule 10b5-1 Arrangement Adopted	true
Adoption Date	8/22/2023
Arrangement Duration	252 days
Aggregate Available	9,224	9,224
Reshma Kewalramani [Member]
Trading Arrangements, by Individual
Name	Reshma Kewalramani
Title	President, Chief Executive Officer and Director
Rule 10b5-1 Arrangement Adopted	true
Adoption Date	8/11/2023
Arrangement Duration	370 days
Aggregate Available	27,330	27,330
Jeffrey M. Leiden [Member]
Trading Arrangements, by Individual
Name	Jeffrey M. Leiden
Title	Executive Chairman
Rule 10b5-1 Arrangement Adopted	true
Adoption Date	8/4/2023
Arrangement Duration	650 days
Aggregate Available	40,454	40,454
Bastiano Sanna [Member]
Trading Arrangements, by Individual
Name	Bastiano Sanna
Title	EVP, Chief of Cell and Genetic Therapies
Rule 10b5-1 Arrangement Adopted	true
Adoption Date	8/25/2023
Arrangement Duration	350 days
Aggregate Available	32,833	32,833
Charles F. Wagner, Jr. [Member]
Trading Arrangements, by Individual
Name	Charles F. Wagner, Jr.
Title	EVP, Chief Financial Officer
Rule 10b5-1 Arrangement Adopted	true
Adoption Date	8/18/2023
Arrangement Duration	357 days
Aggregate Available	6,000	6,000

Basis of Presentation and Acc_2

Basis of Presentation and Accounting Policies (Policies)	9 Months Ended
	Sep. 30, 2023
Accounting Policies [Abstract]
Basis of Presentation	Basis of Presentation The accompanying condensed consolidated financial statements are unaudited and have been prepared by Vertex Pharmaceuticals Incorporated (“Vertex,” “we,” “us” or “our”) in accordance with accounting principles generally accepted in the United States of America (“U.S. GAAP”). The condensed consolidated financial statements reflect the operations of Vertex and our wholly-owned subsidiaries. All material intercompany balances and transactions have been eliminated. We have reclassified certain items from the prior year’s condensed consolidated balance sheet to conform to the current year’s presentation. We operate in one segment, pharmaceuticals. Certain information and footnote disclosures normally included in our Annual Report on Form 10-K for the fiscal year ended December 31, 2022 (the “2022 Annual Report on Form 10-K”) have been condensed or omitted. These interim financial statements, in the opinion of management, reflect all normal recurring adjustments necessary for a fair presentation of the financial position and results of income for the interim periods ended September 30, 2023 and 2022.
Use of Estimates	Use of Estimates The preparation of condensed consolidated financial statements in accordance with U.S. GAAP requires us to make certain estimates and assumptions that affect the reported amounts of assets and liabilities and disclosure of contingent assets and liabilities at the date of our condensed consolidated financial statements, and the amounts of revenues and expenses during the reported periods. We base our estimates on historical experience and various other assumptions, including in certain circumstances future projections that we believe to be reasonable under the circumstances. Actual results could differ from those estimates. Changes in estimates are reflected in reported results in the period in which they become known.

Revenue Recognition (Tables)

Revenue Recognition (Tables)	9 Months Ended
	Sep. 30, 2023
Revenue from Contract with Customer [Abstract]
Schedule of Disaggregation of Revenue	“Product revenues, net” consisted of the following: Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 (in millions) TRIKAFTA/KAFTRIO $ 2,274.3 $ 2,010.5 $ 6,611.4 $ 5,665.3 KALYDECO 112.8 139.4 363.1 417.1 ORKAMBI 63.0 146.2 281.8 399.9 SYMDEKO/SYMKEVI 33.4 38.2 95.2 145.7 Total product revenues, net $ 2,483.5 $ 2,334.3 $ 7,351.5 $ 6,628.0 “Product revenues, net” by geographic region, based on the location of the customer, consisted of the following: Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 (in millions) United States $ 1,554.2 $ 1,455.6 $ 4,465.8 $ 4,238.9 Outside of the United States Europe 766.5 730.5 2,373.7 2,018.3 Other 162.8 148.2 512.0 370.8 Total product revenues outside of the United States 929.3 878.7 2,885.7 2,389.1 Total product revenues, net $ 2,483.5 $ 2,334.3 $ 7,351.5 $ 6,628.0

Earnings Per Share (Tables)

Earnings Per Share (Tables)	9 Months Ended
	Sep. 30, 2023
Earnings Per Share [Abstract]
Schedule of Earnings Per Share, Basic and Diluted	The following table sets forth the computation of basic and diluted net income per common share for the periods ended: Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 (in millions, except per share amounts) Net income $ 1,035.3 $ 930.5 $ 2,650.8 $ 2,503.1 Basic weighted-average common shares outstanding 258.0 256.5 257.7 255.8 Effect of potentially dilutive securities: Stock options 1.2 1.4 1.2 1.4 Restricted stock units (including PSUs) 1.4 1.6 1.5 1.4 Employee stock purchase program 0.0 0.0 0.0 0.1 Diluted weighted-average common shares outstanding 260.6 259.5 260.4 258.7 Basic net income per common share $ 4.01 $ 3.63 $ 10.29 $ 9.78 Diluted net income per common share $ 3.97 $ 3.59 $ 10.18 $ 9.68
Schedule of Potential Gross Common Equivalent Shares	We did not include the securities in the following table in the computation of the diluted net income per common share because the effect would have been anti-dilutive during each period: Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 (in millions) Stock options — — 0.0 0.0 Unvested restricted stock units (including PSUs) — 0.0 0.2 0.2

Fair Value Measurements (Tables

Fair Value Measurements (Tables)	9 Months Ended
	Sep. 30, 2023
Fair Value Disclosures [Abstract]
Schedule of Financial Assets Subject to Fair Value Measurements	The following tables set forth our financial assets and liabilities subject to fair value measurements by level within the fair value hierarchy (and does not include $5.5 billion and $3.1 billion of cash as of September 30, 2023 and December 31, 2022, respectively): As of September 30, 2023 As of December 31, 2022 Total Level 1 Level 2 Level 3 Total Level 1 Level 2 Level 3 (in millions) Financial instruments carried at fair value (asset positions): Cash equivalents: Money market funds $ 3,753.4 $ 3,753.4 $ — $ — $ 5,162.6 $ 5,162.6 $ — $ — Time deposits 1,550.0 — 1,550.0 — 2,000.0 — 2,000.0 — U.S. Treasury securities 236.8 236.8 — — — — — — Corporate debt securities — — — — 5.8 — 5.8 — Commercial paper 96.5 — 96.5 — 204.5 — 204.5 — Marketable securities: Corporate equity securities 46.4 46.4 — — 116.8 88.8 28.0 — U.S. Treasury securities 408.2 408.2 — — — — — — Government-sponsored enterprise securities 421.0 421.0 — — 127.1 127.1 — — Asset-backed securities 237.8 — 237.8 — — — — — Certificates of deposit 31.7 — 31.7 — — — — — Corporate debt securities 1,214.2 — 1,214.2 — 87.0 — 87.0 — Commercial paper 158.7 — 158.7 — 55.8 — 55.8 — Prepaid expenses and other current assets: Foreign currency forward contracts 37.8 — 37.8 — 47.5 — 47.5 — Other assets: Foreign currency forward contracts 3.4 — 3.4 — 0.8 — 0.8 — Total financial assets $ 8,195.9 $ 4,865.8 $ 3,330.1 $ — $ 7,807.9 $ 5,378.5 $ 2,429.4 $ — Financial instruments carried at fair value (liability positions): Other current liabilities: Foreign currency forward contracts $ (0.7) $ — $ (0.7) $ — $ (14.3) $ — $ (14.3) $ — Contingent consideration (15.0) — — (15.0) (14.6) — — (14.6) Other long-term liabilities: Foreign currency forward contracts — — — — (0.9) — (0.9) — Contingent consideration (112.7) — — (112.7) (114.4) — — (114.4) Total financial liabilities $ (128.4) $ — $ (0.7) $ (127.7) $ (144.2) $ — $ (15.2) $ (129.0)
Schedule of Fair Value of Our Contingent Consideration Liabilities	The following table represents a rollforward of the fair value of our contingent consideration liabilities: Nine Months Ended September 30, 2023 (in millions) Balance at December 31, 2022 $ 129.0 Decrease in fair value of contingent payments (1.3) Balance at September 30, 2023 $ 127.7

Marketable Securities and Equ_2

Marketable Securities and Equity Investments (Tables)	9 Months Ended
	Sep. 30, 2023
Investments, Debt and Equity Securities [Abstract]
Schedule of Cash Equivalents and Marketable Securities	A summary of our cash equivalents and marketable securities, which are recorded at fair value (and do not include $5.5 billion and $3.1 billion of cash as of September 30, 2023 and December 31, 2022, respectively), is shown below: As of September 30, 2023 As of December 31, 2022 Amortized Cost Gross Gross Fair Value Amortized Cost Gross Gross Fair Value (in millions) Cash equivalents: Money market funds $ 3,753.4 $ — $ — $ 3,753.4 $ 5,162.6 $ — $ — $ 5,162.6 Time deposits 1,550.0 — — 1,550.0 2,000.0 — — 2,000.0 U.S. Treasury securities 236.8 — — 236.8 — — — — Corporate debt securities — — — — 5.8 — — 5.8 Commercial paper 96.5 — — 96.5 204.5 — — 204.5 Total cash equivalents $ 5,636.7 $ — $ — $ 5,636.7 $ 7,372.9 $ — $ — $ 7,372.9 Marketable securities: U.S. Treasury securities $ 414.6 $ 0.1 $ (6.5) $ 408.2 $ — $ — $ — $ — Government-sponsored enterprise securities 422.9 — (1.9) 421.0 127.0 0.2 (0.1) 127.1 Asset-backed securities 239.3 0.0 (1.5) 237.8 — — — — Certificates of deposit 31.7 0.0 — 31.7 — — — — Corporate debt securities 1,228.4 0.0 (14.2) 1,214.2 87.2 — (0.2) 87.0 Commercial paper 158.8 0.0 (0.1) 158.7 55.8 — — 55.8 Total marketable debt securities 2,495.7 0.1 (24.2) 2,471.6 270.0 0.2 (0.3) 269.9 Corporate equity securities 72.1 0.5 (26.2) 46.4 104.4 30.9 (18.5) 116.8 Total marketable securities $ 2,567.8 $ 0.6 $ (50.4) $ 2,518.0 $ 374.4 $ 31.1 $ (18.8) $ 386.7 Available-for-sale debt securities were classified on our condensed consolidated balance sheets at fair value as follows: As of September 30, 2023 As of December 31, 2022 (in millions) Cash and cash equivalents $ 4,086.7 $ 5,372.9 Marketable securities 771.6 157.7 Long-term marketable securities 1,700.0 112.2 Total $ 6,558.3 $ 5,642.8 Available-for-sale debt securities by contractual maturity were as follows: As of September 30, 2023 As of December 31, 2022 (in millions) Matures within one year $ 4,858.3 $ 5,530.6 Matures after one year through five years 1,700.0 112.2 Total $ 6,558.3 $ 5,642.8
Schedule of Company's Net Unrealized (Losses) Gains on Corporate Equity Securities	During the three and nine months ended September 30, 2023 and 2022, our net unrealized (losses) gains on corporate equity securities held at the conclusion of each period were as follows: Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 (in millions) Net unrealized (losses) gains $ (6.2) $ 16.7 $ (7.1) $ (143.1)

Accumulated Other Comprehensi_2

Accumulated Other Comprehensive Income (Loss) (Tables)	9 Months Ended
	Sep. 30, 2023
Equity [Abstract]
Schedule of Accumulated Other Comprehensive Income (Loss)	The following table summarizes the changes in accumulated other comprehensive income (loss) by component: Unrealized Holding Gains (Losses), Net of Tax Foreign Currency Translation Adjustment On Available-For-Sale Debt Securities On Foreign Currency Forward Contracts Total (in millions) Balance at December 31, 2022 $ (25.0) $ (0.1) $ 25.9 $ 0.8 Other comprehensive income (loss) before reclassifications 9.1 (18.8) 31.8 22.1 Amounts reclassified from accumulated other comprehensive income (loss) — — (25.9) (25.9) Net current period other comprehensive income (loss) 9.1 (18.8) 5.9 (3.8) Balance at September 30, 2023 $ (15.9) $ (18.9) $ 31.8 $ (3.0) Balance at December 31, 2021 $ (13.6) $ (0.5) $ 30.0 $ 15.9 Other comprehensive (loss) income before reclassifications (42.8) (3.6) 230.2 183.8 Amounts reclassified from accumulated other comprehensive income (loss) — — (102.1) (102.1) Net current period other comprehensive (loss) income (42.8) (3.6) 128.1 81.7 Balance at September 30, 2022 $ (56.4) $ (4.1) $ 158.1 $ 97.6

Hedging (Tables)

Hedging (Tables)	9 Months Ended
	Sep. 30, 2023
Derivative Instruments and Hedging Activities Disclosure [Abstract]
Schedule of Cash Flow Hedging Instruments	The following table summarizes the notional amount in U.S. dollars of our outstanding foreign currency forward contracts designated as cash flow hedges under U.S. GAAP: As of September 30, 2023 As of December 31, 2022 Foreign Currency (in millions) Euro $ 1,343.3 $ 1,497.7 Canadian dollar 192.6 216.3 British pound sterling 191.9 247.4 Australian dollar 136.2 174.9 Swiss Franc 51.7 65.2 Total foreign currency forward contracts $ 1,915.7 $ 2,201.5
Schedule of Foreign Exchange Contracts, Condensed Consolidated Statements of Operations	During the three and nine months ended September 30, 2023 and 2022, we recognized the following related to foreign currency forward contracts in our condensed consolidated statements of income: Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 (in millions) Designated as hedging instruments - Reclassified from AOCI Product revenues, net $ 2.8 $ 65.2 $ 33.0 $ 130.3 Not designated as hedging instruments Other (expense) income, net $ (22.0) $ (22.1) $ (17.8) $ (38.9) Total reported in the Condensed Consolidated Statements of Income Product revenues, net $ 2,483.5 $ 2,334.3 $ 7,351.5 $ 6,628.0 Other (expense) income, net $ (15.9) $ 17.2 $ (13.0) $ (133.7)
Schedule of Foreign Exchange Contracts	The following table summarizes the fair value of our outstanding foreign currency forward contracts designated as cash flow hedges under U.S. GAAP included on our condensed consolidated balance sheets: As of September 30, 2023 Assets Liabilities Classification Fair Value Classification Fair Value (in millions) Prepaid expenses and other current assets $ 37.8 Other current liabilities $ (0.7) Other assets 3.4 Other long-term liabilities — Total assets $ 41.2 Total liabilities $ (0.7) As of December 31, 2022 Assets Liabilities Classification Fair Value Classification Fair Value (in millions) Prepaid expenses and other current assets $ 47.5 Other current liabilities $ (14.3) Other assets 0.8 Other long-term liabilities (0.9) Total assets $ 48.3 Total liabilities $ (15.2)
Schedule of Offsetting Assets	The following table summarizes the potential effect of offsetting derivatives by type of financial instrument designated as cash flow hedges under U.S. GAAP on our condensed consolidated balance sheets: As of September 30, 2023 Gross Amounts Recognized Gross Amounts Offset Gross Amounts Presented Gross Amounts Not Offset Legal Offset Foreign currency forward contracts (in millions) Total assets $ 41.2 $ — $ 41.2 $ (0.7) $ 40.5 Total liabilities (0.7) — (0.7) 0.7 — As of December 31, 2022 Gross Amounts Recognized Gross Amounts Offset Gross Amounts Presented Gross Amounts Not Offset Legal Offset Foreign currency forward contracts (in millions) Total assets $ 48.3 $ — $ 48.3 $ (15.2) $ 33.1 Total liabilities (15.2) — (15.2) 15.2 —
Schedule of Offsetting Liabilities	The following table summarizes the potential effect of offsetting derivatives by type of financial instrument designated as cash flow hedges under U.S. GAAP on our condensed consolidated balance sheets: As of September 30, 2023 Gross Amounts Recognized Gross Amounts Offset Gross Amounts Presented Gross Amounts Not Offset Legal Offset Foreign currency forward contracts (in millions) Total assets $ 41.2 $ — $ 41.2 $ (0.7) $ 40.5 Total liabilities (0.7) — (0.7) 0.7 — As of December 31, 2022 Gross Amounts Recognized Gross Amounts Offset Gross Amounts Presented Gross Amounts Not Offset Legal Offset Foreign currency forward contracts (in millions) Total assets $ 48.3 $ — $ 48.3 $ (15.2) $ 33.1 Total liabilities (15.2) — (15.2) 15.2 —

Inventories (Tables)

Inventories (Tables)	9 Months Ended
	Sep. 30, 2023
Inventory Disclosure [Abstract]
Schedule of Inventories by Type	Inventories consisted of the following: As of September 30, 2023 As of December 31, 2022 (in millions) Raw materials $ 77.5 $ 38.1 Work-in-process 498.3 260.7 Finished goods 112.9 161.8 Total $ 688.7 $ 460.6

Stock-based Compensation Expe_2

Stock-based Compensation Expense and Share Repurchase Programs (Tables)	9 Months Ended
	Sep. 30, 2023
Share-Based Payment Arrangement [Abstract]
Schedule of Stock-based Compensation Expense by Line Item	During the three and nine months ended September 30, 2023 and 2022, we recognized the following stock-based compensation expense: Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 (in millions) Stock-based compensation expense by type of award: Restricted stock units (including PSUs) $ 129.1 $ 130.3 $ 358.6 $ 351.5 Stock options 0.2 3.1 4.0 14.9 ESPP share issuances 2.4 1.9 11.8 13.0 Stock-based compensation expense related to inventories (0.8) 0.3 (1.8) 0.4 Total stock-based compensation expense included in “Total costs and expenses” $ 130.9 $ 135.6 $ 372.6 $ 379.8 Stock-based compensation expense by line item: Cost of sales $ 1.7 $ 2.4 $ 5.4 $ 7.0 Research and development expenses 81.1 80.0 231.9 229.9 Selling, general and administrative expenses 48.1 53.2 135.3 142.9 Total stock-based compensation expense included in costs and expenses 130.9 135.6 372.6 379.8 Income tax effect (37.1) (38.8) (109.0) (101.3) Total stock-based compensation expense, net of tax $ 93.8 $ 96.8 $ 263.6 $ 278.5

Income Taxes (Tables)

Income Taxes (Tables)	9 Months Ended
	Sep. 30, 2023
Income Tax Disclosure [Abstract]
Schedule of Provision for (Benefits from) Income Taxes and Effective Tax rates	During the three and nine months ended September 30, 2023 and 2022, we recorded the following provisions for income taxes and effective tax rates as compared to our income before provision for income taxes: Three Months Ended September 30, Nine Months Ended September 30, 2023 2022 2023 2022 (in millions, except percentages) Income before provision for income taxes $ 1,179.2 $ 1,176.4 $ 3,232.2 $ 3,155.6 Provision for income taxes $ 143.9 $ 245.9 $ 581.4 $ 652.5 Effective tax rate 12.2 % 20.9 % 18.0 % 20.7 %

Additional Cash Flow Informat_2

Additional Cash Flow Information (Tables)	9 Months Ended
	Sep. 30, 2023
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Schedule of Additional Cash Flow Information	The cash, cash equivalents and restricted cash at the beginning and ending of each period presented in our condensed consolidated statements of cash flows consisted of the following: Nine Months Ended September 30, 2023 2022 Beginning of period End of period Beginning of period End of period (in millions) Cash and cash equivalents $ 10,504.0 $ 11,110.2 $ 6,795.0 $ 9,171.5 Prepaid expenses and other current assets 8.0 6.4 5.1 5.5 Cash, cash equivalents and restricted cash per condensed consolidated statement of cash flows $ 10,512.0 $ 11,116.6 $ 6,800.1 $ 9,177.0

Basis of Presentation and Acc_3

Basis of Presentation and Accounting Policies (Details)	9 Months Ended
	Sep. 30, 2023 segment
Accounting Policies [Abstract]
Number of operating segments	1

Revenue Recognition - Disaggreg

Revenue Recognition - Disaggregation of Revenue (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Disaggregation of Revenue [Line Items]
Product revenues, net	$ 2,483.5	$ 2,334.3	$ 7,351.5	$ 6,628
United States
Disaggregation of Revenue [Line Items]
Product revenues, net	1,554.2	1,455.6	4,465.8	4,238.9
Total product revenues outside of the United States
Disaggregation of Revenue [Line Items]
Product revenues, net	929.3	878.7	2,885.7	2,389.1
Europe
Disaggregation of Revenue [Line Items]
Product revenues, net	766.5	730.5	2,373.7	2,018.3
Other
Disaggregation of Revenue [Line Items]
Product revenues, net	162.8	148.2	512	370.8
TRIKAFTA/KAFTRIO
Disaggregation of Revenue [Line Items]
Product revenues, net	2,274.3	2,010.5	6,611.4	5,665.3
KALYDECO
Disaggregation of Revenue [Line Items]
Product revenues, net	112.8	139.4	363.1	417.1
ORKAMBI
Disaggregation of Revenue [Line Items]
Product revenues, net	63	146.2	281.8	399.9
SYMDEKO/SYMKEVI
Disaggregation of Revenue [Line Items]
Product revenues, net	$ 33.4	$ 38.2	$ 95.2	$ 145.7

Revenue Recognition - Additiona

Revenue Recognition - Additional Information (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Revenue from Contract with Customer [Abstract]
Contract liabilities	$ 157.1	$ 159.6

Acquired In-Process Research _2

Acquired In-Process Research and Development and Other Arrangements - Additional Information (Details)	1 Months Ended					3 Months Ended		9 Months Ended		12 Months Ended
	Sep. 30, 2023 USD ($)	Mar. 31, 2023 USD ($)	Feb. 28, 2023 USD ($)	Jul. 31, 2022 USD ($)	May 31, 2022 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Sep. 30, 2023 USD ($)	Sep. 30, 2022 USD ($)	Dec. 31, 2021 USD ($)	Dec. 31, 2019 USD ($) target
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Acquired in-process research and development expenses						$ 51,700,000	$ 29,000,000	$ 509,300,000	$ 92,900,000
Selling, general and administrative expenses						263,800,000	246,800,000	767,500,000	677,300,000
Septerna, Inc
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Asset acquisition, consideration transferred	$ 47,500,000
Catalyst Biosciences
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Asset acquisition, consideration transferred					$ 60,000,000
CRISPR Therapeutics
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Collaborative arrangement, right to exclusively license, number of targets | target											3
Collaborative arrangement, development and regulatory potential milestone payments maximum											$ 410,000,000
CRISPR JDCA
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Collaborative arrangement, development and regulatory potential milestone payments maximum										$ 200,000,000
Allocation of net profits and net losses, percent										60%
Research and development expenses						74,900,000	45,500,000	193,200,000	120,600,000
Selling, general and administrative expenses						26,000,000	$ 13,500,000	66,100,000	$ 35,300,000
CRISPR JDCA | CRISPR
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Allocation of net profits and net losses, percent										40%
CRISPR T1D
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Acquired in-process research and development expenses								170,000,000
Collaborative arrangement, development and regulatory potential milestone payments maximum								$ 160,000,000
Up-front payment		$ 100,000,000
Milestone payment						$ 70,000,000
Entrada Therapeutics
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Collaborative arrangement, development and regulatory potential milestone payments maximum			$ 485,000,000
Up-front payment			225,100,000
Purchase of common stock			$ 24,900,000
Verve
Collaborative Arrangement and Arrangement Other than Collaborative [Line Items]
Up-front payment				$ 25,000,000
Purchase of common stock				$ 35,000,000

Earnings Per Share - Schedule o

Earnings Per Share - Schedule of Computation (Details) - USD ($) $ / shares in Units, shares in Millions, $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Antidilutive Securities Excluded from Computation of Earnings Per Share
Net income	$ 1,035.3	$ 930.5	$ 2,650.8	$ 2,503.1
Basic weighted-average common shares outstanding (in shares)	258	256.5	257.7	255.8
Effect of potentially dilutive securities:
Employee stock purchase program (in shares)	0	0	0	0.1
Diluted weighted-average common shares outstanding (in shares)	260.6	259.5	260.4	258.7
Basic net income per common share (in dollars per share)	$ 4.01	$ 3.63	$ 10.29	$ 9.78
Diluted net income per common share (in dollars per share)	$ 3.97	$ 3.59	$ 10.18	$ 9.68
Stock options
Effect of potentially dilutive securities:
Share-based payment arrangements (in shares)	1.2	1.4	1.2	1.4
Restricted stock units (including PSUs)
Effect of potentially dilutive securities:
Share-based payment arrangements (in shares)	1.4	1.6	1.5	1.4

Earnings Per Share - Anti-dilut

Earnings Per Share - Anti-dilutive Securities (Details) - shares shares in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Stock options
Antidilutive Securities Excluded from Computation of Earnings Per Share
Antidilutive securities excluded from computation of earnings per share (in shares)	0	0	0	0
Unvested restricted stock units (including PSUs)
Antidilutive Securities Excluded from Computation of Earnings Per Share
Antidilutive securities excluded from computation of earnings per share (in shares)	0	0	0.2	0.2

Fair Value Measurements - Addit

Fair Value Measurements - Additional Information (Details) $ in Millions	Sep. 30, 2023 USD ($)	Dec. 31, 2022 USD ($)
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Cash	$ 5,500	$ 3,100
Level 3
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Remaining milestone payment	$ 678.3
Level 3 | Minimum | Discount Rate
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration, measurement input (as a percent)	0.055
Level 3 | Maximum | Discount Rate
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Contingent consideration, measurement input (as a percent)	0.065
Corporate equity securities
Fair Value, Assets and Liabilities Measured on Recurring and Nonrecurring Basis [Line Items]
Investments with restrictions	$ 25.5

Fair Value Measurements - Finan

Fair Value Measurements - Financial Assets and Liabilities Subject to Fair Value Measurements (Details) - Recurring Basis - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Financial instruments carried at fair value (asset positions):
Prepaid expenses and other current assets, foreign currency forward contracts	$ 37.8	$ 47.5
Other assets, foreign currency forward contracts	3.4	0.8
Total financial assets	8,195.9	7,807.9
Financial instruments carried at fair value (liability positions):
Other current liabilities, foreign currency forward contracts	(0.7)	(14.3)
Other current liabilities, contingent consideration	(15)	(14.6)
Other long-term liabilities, foreign currency forward contracts	0	(0.9)
Contingent consideration	(112.7)	(114.4)
Total financial liabilities	(128.4)	(144.2)
Level 1
Financial instruments carried at fair value (asset positions):
Prepaid expenses and other current assets, foreign currency forward contracts	0	0
Other assets, foreign currency forward contracts	0	0
Total financial assets	4,865.8	5,378.5
Financial instruments carried at fair value (liability positions):
Other current liabilities, foreign currency forward contracts	0	0
Other current liabilities, contingent consideration	0	0
Other long-term liabilities, foreign currency forward contracts	0	0
Contingent consideration	0	0
Total financial liabilities	0	0
Level 2
Financial instruments carried at fair value (asset positions):
Prepaid expenses and other current assets, foreign currency forward contracts	37.8	47.5
Other assets, foreign currency forward contracts	3.4	0.8
Total financial assets	3,330.1	2,429.4
Financial instruments carried at fair value (liability positions):
Other current liabilities, foreign currency forward contracts	(0.7)	(14.3)
Other current liabilities, contingent consideration	0	0
Other long-term liabilities, foreign currency forward contracts	0	(0.9)
Contingent consideration	0	0
Total financial liabilities	(0.7)	(15.2)
Level 3
Financial instruments carried at fair value (asset positions):
Prepaid expenses and other current assets, foreign currency forward contracts	0	0
Other assets, foreign currency forward contracts	0	0
Total financial assets	0	0
Financial instruments carried at fair value (liability positions):
Other current liabilities, foreign currency forward contracts	0	0
Other current liabilities, contingent consideration	(15)	(14.6)
Other long-term liabilities, foreign currency forward contracts	0	0
Contingent consideration	(112.7)	(114.4)
Total financial liabilities	(127.7)	(129)
Money market funds
Financial instruments carried at fair value (asset positions):
Cash equivalents:	3,753.4	5,162.6
Money market funds | Level 1
Financial instruments carried at fair value (asset positions):
Cash equivalents:	3,753.4	5,162.6
Money market funds | Level 2
Financial instruments carried at fair value (asset positions):
Cash equivalents:	0	0
Money market funds | Level 3
Financial instruments carried at fair value (asset positions):
Cash equivalents:	0	0
Time deposits
Financial instruments carried at fair value (asset positions):
Cash equivalents:	1,550	2,000
Time deposits | Level 1
Financial instruments carried at fair value (asset positions):
Cash equivalents:	0	0
Time deposits | Level 2
Financial instruments carried at fair value (asset positions):
Cash equivalents:	1,550	2,000
Time deposits | Level 3
Financial instruments carried at fair value (asset positions):
Cash equivalents:	0	0
Corporate equity securities
Financial instruments carried at fair value (asset positions):
Marketable securities:	46.4	116.8
Corporate equity securities | Level 1
Financial instruments carried at fair value (asset positions):
Marketable securities:	46.4	88.8
Corporate equity securities | Level 2
Financial instruments carried at fair value (asset positions):
Marketable securities:	0	28
Corporate equity securities | Level 3
Financial instruments carried at fair value (asset positions):
Marketable securities:	0	0
U.S. Treasury securities
Financial instruments carried at fair value (asset positions):
Cash equivalents:	236.8	0
Marketable securities:	408.2	0
U.S. Treasury securities | Level 1
Financial instruments carried at fair value (asset positions):
Cash equivalents:	236.8	0
Marketable securities:	408.2	0
U.S. Treasury securities | Level 2
Financial instruments carried at fair value (asset positions):
Cash equivalents:	0	0
Marketable securities:	0	0
U.S. Treasury securities | Level 3
Financial instruments carried at fair value (asset positions):
Cash equivalents:	0	0
Marketable securities:	0	0
Government-sponsored enterprise securities
Financial instruments carried at fair value (asset positions):
Marketable securities:	421	127.1
Government-sponsored enterprise securities | Level 1
Financial instruments carried at fair value (asset positions):
Marketable securities:	421	127.1
Government-sponsored enterprise securities | Level 2
Financial instruments carried at fair value (asset positions):
Marketable securities:	0	0
Government-sponsored enterprise securities | Level 3
Financial instruments carried at fair value (asset positions):
Marketable securities:	0	0
Asset-backed securities
Financial instruments carried at fair value (asset positions):
Marketable securities:	237.8	0
Asset-backed securities | Level 1
Financial instruments carried at fair value (asset positions):
Marketable securities:	0	0
Asset-backed securities | Level 2
Financial instruments carried at fair value (asset positions):
Marketable securities:	237.8	0
Asset-backed securities | Level 3
Financial instruments carried at fair value (asset positions):
Marketable securities:	0	0
Certificates of deposit
Financial instruments carried at fair value (asset positions):
Marketable securities:	31.7	0
Certificates of deposit | Level 1
Financial instruments carried at fair value (asset positions):
Marketable securities:	0	0
Certificates of deposit | Level 2
Financial instruments carried at fair value (asset positions):
Marketable securities:	31.7	0
Certificates of deposit | Level 3
Financial instruments carried at fair value (asset positions):
Marketable securities:	0	0
Corporate debt securities
Financial instruments carried at fair value (asset positions):
Cash equivalents:	0	5.8
Marketable securities:	1,214.2	87
Corporate debt securities | Level 1
Financial instruments carried at fair value (asset positions):
Cash equivalents:	0	0
Marketable securities:	0	0
Corporate debt securities | Level 2
Financial instruments carried at fair value (asset positions):
Cash equivalents:	0	5.8
Marketable securities:	1,214.2	87
Corporate debt securities | Level 3
Financial instruments carried at fair value (asset positions):
Cash equivalents:	0	0
Marketable securities:	0	0
Commercial paper
Financial instruments carried at fair value (asset positions):
Cash equivalents:	96.5	204.5
Marketable securities:	158.7	55.8
Commercial paper | Level 1
Financial instruments carried at fair value (asset positions):
Cash equivalents:	0	0
Marketable securities:	0	0
Commercial paper | Level 2
Financial instruments carried at fair value (asset positions):
Cash equivalents:	96.5	204.5
Marketable securities:	158.7	55.8
Commercial paper | Level 3
Financial instruments carried at fair value (asset positions):
Cash equivalents:	0	0
Marketable securities:	$ 0	$ 0

Fair Value Measurements - Fair

Fair Value Measurements - Fair Value of Contingent Consideration Liabilities (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Fair Value, Liabilities Measured on Recurring Basis, Unobservable Input Reconciliation, Calculation [Roll Forward]
Beginning balance			$ 129
Decrease in fair value of contingent payments	$ 1.2	$ (2.6)	(1.3)	$ (59.3)
Ending balance	$ 127.7		$ 127.7

Marketable Securities and Equ_3

Marketable Securities and Equity Investments - Additional Information (Details) - USD ($)	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Summary of cash, cash equivalents and marketable securities
Cash	$ 5,500,000,000		$ 3,100,000,000
Allowance for credit loss for available-for-sale debt securities	0	$ 0
Debt securities fair value, unrealized loss position	2,280,000,000
Unrealized loss	24,200,000
Unrealized loss position for greater than twelve months	0
Original cost	72,100,000		$ 104,400,000
Publicly Traded Companies Sale
Summary of cash, cash equivalents and marketable securities
Proceeds received	95,100,000	$ 0
Original cost	57,300,000
Other Assets
Summary of cash, cash equivalents and marketable securities
Equity securities without readily determinable fair value, amount	$ 98,600,000

Marketable Securities and Equ_4

Marketable Securities and Equity Investments - Summary of Cash Equivalents and Marketable Securities (Details) - USD ($) $ in Millions	9 Months Ended	12 Months Ended
	Sep. 30, 2023	Dec. 31, 2022
Cash equivalents:
Amortized Cost	$ 5,636.7	$ 7,372.9
Fair Value	5,636.7	7,372.9
Total marketable debt securities
Gross Unrealized Losses	(24.2)
Fair Value	6,558.3	5,642.8
Corporate equity securities
Amortized Cost	72.1	104.4
Gross Unrealized Gains	0.5	30.9
Gross Unrealized Losses	(26.2)	(18.5)
Fair Value	46.4	116.8
Amortized Cost	2,567.8	374.4
Gross Unrealized Gains	0.6	31.1
Gross Unrealized Losses	(50.4)	(18.8)
Fair Value	2,518	386.7
Money market funds
Cash equivalents:
Amortized Cost	3,753.4	5,162.6
Fair Value	3,753.4	5,162.6
Time deposits
Cash equivalents:
Amortized Cost	1,550	2,000
Fair Value	1,550	2,000
U.S. Treasury securities
Cash equivalents:
Amortized Cost	236.8	0
Fair Value	236.8	0
Total marketable debt securities
Amortized Cost	414.6	0
Gross Unrealized Gains	0.1	0
Gross Unrealized Losses	(6.5)	0
Fair Value	408.2	0
Government-sponsored enterprise securities
Total marketable debt securities
Amortized Cost	422.9	127
Gross Unrealized Gains	0	0.2
Gross Unrealized Losses	(1.9)	(0.1)
Fair Value	421	127.1
Asset-backed securities
Total marketable debt securities
Amortized Cost	239.3	0
Gross Unrealized Gains	0	0
Gross Unrealized Losses	(1.5)	0
Fair Value	237.8	0
Certificates of deposit
Total marketable debt securities
Amortized Cost	31.7	0
Gross Unrealized Gains	0	0
Gross Unrealized Losses	0	0
Fair Value	31.7	0
Corporate debt securities
Cash equivalents:
Amortized Cost	0	5.8
Fair Value	0	5.8
Total marketable debt securities
Amortized Cost	1,228.4	87.2
Gross Unrealized Gains	0	0
Gross Unrealized Losses	(14.2)	(0.2)
Fair Value	1,214.2	87
Commercial paper
Cash equivalents:
Amortized Cost	96.5	204.5
Fair Value	96.5	204.5
Commercial paper
Total marketable debt securities
Amortized Cost	158.8	55.8
Gross Unrealized Gains	0	0
Gross Unrealized Losses	(0.1)	0
Fair Value	158.7	55.8
Total marketable debt securities
Total marketable debt securities
Amortized Cost	2,495.7	270
Gross Unrealized Gains	0.1	0.2
Gross Unrealized Losses	(24.2)	(0.3)
Fair Value	$ 2,471.6	$ 269.9

Marketable Securities and Equ_5

Marketable Securities and Equity Investments - Available-for-Sale Debt Securities at Fair Value (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Debt Securities, Available-for-sale [Line Items]
Debt securities	$ 6,558.3	$ 5,642.8
Cash and cash equivalents
Debt Securities, Available-for-sale [Line Items]
Debt securities	4,086.7	5,372.9
Marketable securities
Debt Securities, Available-for-sale [Line Items]
Debt securities	771.6	157.7
Long-term marketable securities
Debt Securities, Available-for-sale [Line Items]
Debt securities	$ 1,700	$ 112.2

Marketable Securities and Equ_6

Marketable Securities and Equity Investments - Available-for-Sale Debt Securities by Contractual Maturity (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Investments, Debt and Equity Securities [Abstract]
Matures within one year	$ 4,858.3	$ 5,530.6
Matures after one year through five years	1,700	112.2
Total	$ 6,558.3	$ 5,642.8

Marketable Securities and Equ_7

Marketable Securities and Equity Investments - Net Unrealized Gains (Losses) (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Investments, Debt and Equity Securities [Abstract]
Net unrealized (losses) gains	$ (6.2)	$ 16.7	$ (7.1)	$ (143.1)

Accumulated Other Comprehensi_3

Accumulated Other Comprehensive Income (Loss) (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Beginning balance	$ 15,470.2	$ 11,933.5	$ 13,912.7	$ 10,100
Other comprehensive income (loss) before reclassifications			22.1	183.8
Amounts reclassified from accumulated other comprehensive income (loss)			(25.9)	(102.1)
Total other comprehensive income (loss)	36.8	40.1	(3.8)	81.7
Ending balance	16,512.8	13,029.6	16,512.8	13,029.6
Total
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Beginning balance	(39.8)	57.5	0.8	15.9
Total other comprehensive income (loss)	36.8	40.1	(3.8)	81.7
Ending balance	(3)	97.6	(3)	97.6
Foreign Currency Translation Adjustment
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Beginning balance			(25)	(13.6)
Other comprehensive income (loss) before reclassifications			9.1	(42.8)
Amounts reclassified from accumulated other comprehensive income (loss)			0	0
Total other comprehensive income (loss)			9.1	(42.8)
Ending balance	(15.9)	(56.4)	(15.9)	(56.4)
On Available-For-Sale Debt Securities
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Beginning balance			(0.1)	(0.5)
Other comprehensive income (loss) before reclassifications			(18.8)	(3.6)
Amounts reclassified from accumulated other comprehensive income (loss)			0	0
Total other comprehensive income (loss)			(18.8)	(3.6)
Ending balance	(18.9)	(4.1)	(18.9)	(4.1)
On Foreign Currency Forward Contracts
AOCI Attributable to Parent, Net of Tax [Roll Forward]
Beginning balance			25.9	30
Other comprehensive income (loss) before reclassifications			31.8	230.2
Amounts reclassified from accumulated other comprehensive income (loss)			(25.9)	(102.1)
Total other comprehensive income (loss)			5.9	128.1
Ending balance	$ 31.8	$ 158.1	$ 31.8	$ 158.1

Hedging - Additional Informatio

Hedging - Additional Information (Details) - Foreign currency forward contracts $ in Millions	9 Months Ended
	Sep. 30, 2023 USD ($)
Not Designated as Hedging Instrument
Derivative [Line Items]
Derivative term	1 month
Notional amount of foreign currency forward contract	$ 922.8
Cash Flow Hedging | Minimum
Derivative [Line Items]
Derivative term	1 month
Cash Flow Hedging | Maximum
Derivative [Line Items]
Derivative term	18 months

Hedging - Notional Amount (Deta

Hedging - Notional Amount (Details) - Foreign currency forward contracts - Designated as Hedging Instruments - Cash Flow Hedging - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Derivative [Line Items]
Notional amount of foreign currency forward contract	$ 1,915.7	$ 2,201.5
Euro
Derivative [Line Items]
Notional amount of foreign currency forward contract	1,343.3	1,497.7
Canadian dollar
Derivative [Line Items]
Notional amount of foreign currency forward contract	192.6	216.3
British pound sterling
Derivative [Line Items]
Notional amount of foreign currency forward contract	191.9	247.4
Australian dollar
Derivative [Line Items]
Notional amount of foreign currency forward contract	136.2	174.9
Swiss Franc
Derivative [Line Items]
Notional amount of foreign currency forward contract	$ 51.7	$ 65.2

Hedging - Cash Flow Hedging Ins

Hedging - Cash Flow Hedging Instruments (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Derivative Instruments, Gain (Loss) [Line Items]
Product revenues, net	$ 2,483.5	$ 2,334.3	$ 7,351.5	$ 6,628
Other (expense) income, net	(15.9)	17.2	(13)	(133.7)
Foreign Currency Forward Contract | Reclassification out of Accumulated Other Comprehensive Income | Foreign currency forward contracts | Designated as hedging instruments
Derivative Instruments, Gain (Loss) [Line Items]
Product revenues, net	2.8	65.2	33	130.3
Foreign Currency Forward Contract | Reclassification out of Accumulated Other Comprehensive Income | Foreign currency forward contracts | Not designated as hedging instruments
Derivative Instruments, Gain (Loss) [Line Items]
Other (expense) income, net	$ (22)	$ (22.1)	$ (17.8)	$ (38.9)

Hedging - Derivative Fair Value

Hedging - Derivative Fair Value (Details) - Designated as Hedging Instruments - Foreign currency forward contracts - Cash Flow Hedging - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Derivative [Line Items]
Total assets	$ 41.2	$ 48.3
Total liabilities	(0.7)	(15.2)
Prepaid expenses and other current assets
Derivative [Line Items]
Total assets	37.8	47.5
Other assets
Derivative [Line Items]
Total assets	3.4	0.8
Other current liabilities
Derivative [Line Items]
Total liabilities	(0.7)	(14.3)
Other long-term liabilities
Derivative [Line Items]
Total liabilities	$ 0	$ (0.9)

Hedging - Offsetting Derivative

Hedging - Offsetting Derivatives (Details) - Cash Flow Hedging - Designated as Hedging Instruments - Foreign currency forward contracts - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Offsetting Derivative Assets [Abstract]
Gross Amounts Recognized	$ 41.2	$ 48.3
Gross Amounts Offset	0	0
Gross Amounts Presented	41.2	48.3
Gross Amounts Not Offset	(0.7)	(15.2)
Legal Offset	40.5	33.1
Offsetting Derivative Liabilities [Abstract]
Gross Amounts Recognized	(0.7)	(15.2)
Gross Amounts Offset	0	0
Gross Amounts Presented	(0.7)	(15.2)
Gross Amounts Not Offset	0.7	15.2
Legal Offset	$ 0	$ 0

Inventories (Details)

Inventories (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022
Inventory Disclosure [Abstract]
Raw materials	$ 77.5	$ 38.1
Work-in-process	498.3	260.7
Finished goods	112.9	161.8
Total	$ 688.7	$ 460.6

Stock-based Compensation Expe_3

Stock-based Compensation Expense and Share Repurchase Programs - Stock-based Compensation Expense (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022
Stock-based compensation expense:
Total stock-based compensation expense included in costs and expenses	$ 130.9	$ 135.6	$ 372.6	$ 379.8
Stock-based compensation expense related to inventories	(0.8)	0.3	(1.8)	0.4
Total stock-based compensation expense included in “Total costs and expenses”	130.9	135.6	372.6	379.8
Income tax effect	(37.1)	(38.8)	(109)	(101.3)
Total stock-based compensation expense, net of tax	93.8	96.8	263.6	278.5
Cost of sales
Stock-based compensation expense:
Total stock-based compensation expense included in costs and expenses	1.7	2.4	5.4	7
Research and development expenses
Stock-based compensation expense:
Total stock-based compensation expense included in costs and expenses	81.1	80	231.9	229.9
Selling, general and administrative expenses
Stock-based compensation expense:
Total stock-based compensation expense included in costs and expenses	48.1	53.2	135.3	142.9
Restricted stock units (including PSUs)
Stock-based compensation expense:
Total stock-based compensation expense included in costs and expenses	129.1	130.3	358.6	351.5
Stock options
Stock-based compensation expense:
Total stock-based compensation expense included in costs and expenses	0.2	3.1	4	14.9
ESPP share issuances
Stock-based compensation expense:
Total stock-based compensation expense included in costs and expenses	$ 2.4	$ 1.9	$ 11.8	$ 13

Stock-based Compensation Expe_4

Stock-based Compensation Expense and Share Repurchase Programs - Additional Information (Details) - USD ($)	3 Months Ended	9 Months Ended
	Sep. 30, 2023	Sep. 30, 2023	Feb. 28, 2023
Share-Based Payment Arrangement [Abstract]
Number of shares authorized to be repurchased			$ 3,000,000,000
Shares repurchased (in shares)		891,060
Value of shares repurchased	$ 123,000,000	$ 284,100,000
Stock repurchase program, remaining amount	$ 2,700,000,000	$ 2,700,000,000

Income Taxes (Details)

Income Taxes (Details) - USD ($) $ in Millions	3 Months Ended		9 Months Ended
	Sep. 30, 2023	Sep. 30, 2022	Sep. 30, 2023	Sep. 30, 2022	Dec. 31, 2022
Income Tax Disclosure [Abstract]
Income before provision for income taxes	$ 1,179.2	$ 1,176.4	$ 3,232.2	$ 3,155.6
Provision for income taxes	$ 143.9	$ 245.9	$ 581.4	$ 652.5
Effective tax rate	12.20%	20.90%	18%	20.70%
Net unrecognized tax benefits which would affect the tax rate if recognized	$ 245.4		$ 245.4		$ 208.5

Commitments and Contingencies (

Commitments and Contingencies (Details) - USD ($)	1 Months Ended
	Jul. 31, 2022	Sep. 30, 2023	Dec. 31, 2022
Line of Credit Facility [Line Items]
Indemnification claims		$ 0
Contingent liabilities		$ 0	$ 0
SOFR Loan | Minimum
Line of Credit Facility [Line Items]
Basis spread on variable rate (as a percent)	1%
SOFR Loan | Maximum
Line of Credit Facility [Line Items]
Basis spread on variable rate (as a percent)	1.50%
Revolving Credit Facility
Line of Credit Facility [Line Items]
Line of credit facility, maximum borrowing capacity	$ 500,000,000
Line of credit facility additional borrowing capacity	$ 500,000,000
Debt covenant, consolidated leverage ratio	3.50
Debt covenant, increase in consolidated leverage ratio	4
Revolving Credit Facility | Base Rate | Minimum
Line of Credit Facility [Line Items]
Basis spread on variable rate (as a percent)	0%
Revolving Credit Facility | Base Rate | Maximum
Line of Credit Facility [Line Items]
Basis spread on variable rate (as a percent)	0.50%
Letters of Credit
Line of Credit Facility [Line Items]
Line of credit facility, maximum borrowing capacity	$ 100,000,000

Additional Cash Flow Informat_3

Additional Cash Flow Information (Details) - USD ($) $ in Millions	Sep. 30, 2023	Dec. 31, 2022	Sep. 30, 2022	Dec. 31, 2021
Organization, Consolidation and Presentation of Financial Statements [Abstract]
Cash and cash equivalents	$ 11,110.2	$ 10,504	$ 9,171.5	$ 6,795
Prepaid expenses and other current assets	6.4	8	5.5	5.1
Cash, cash equivalents and restricted cash per condensed consolidated statement of cash flows	$ 11,116.6	$ 10,512	$ 9,177	$ 6,800.1