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<h3>Background and Importance</h3> Telepharmacy offers an innovative approach to ensure continuity of care and patient engagement in chronic conditions requiring specialised medications. Severe asthma patients treated with biologics demand close monitoring of clinical outcomes, biomarkers, and quality of life to optimise therapy and resource utilisation. <h3>Aim and Objectives</h3> To evaluate the usefulness of a dual (in-person and remote) telepharmacy follow-up system for severe asthma patients on biologics by assessing clinical response, biomarkers, and health-related quality of life (HRQoL). <h3>Material and Methods</h3> A multicentre 24–month prospective follow–up was conducted in severe asthma patients receiving biologics from three hospitals. Sociodemographic data, comorbidities, and health habits were collected. Clinical and functional parameters included forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), fractional exhaled nitric oxide (FeNO), eosinophil count, and immunoglobulin E. HRQoL was assessed using validated questionnaires: Asthma Control Test (ACT), FACIT–Fatigue, PROMIS–29, SNOT–22, TSQM, miniAQLQ, and P3CEQ. Correlations between clinical variables and HRQoL outcomes were analysed. <h3>Results</h3> Thirty–seven patients (83.3% women, 46–65 years: 43.3%) were included; 48.7% had comorbidities, mainly hypercholesterolaemia (35.1%). Questionnaire completion rate was 89%, and 37.8% used the telepharmacy chat for queries. Dupilumab was the most frequent biologic (45.2%). Pulmonary function improved: FEV1 increased from 80.1±21.0% to 85.3±16.4%, and FEV1/FVC from 71.0±13.6% to 77.0±11.5%. FeNO decreased significantly (55.8±46.7 to 27.8±21.7 ppb). ACT scores improved from 17.1±6.0 to 22.3±2.2 (p=0.019). HRQoL improved: mini AQLQ symptoms (4.8±1.6 to 6.3±0.6, p=0.031), activity limitation (5.2±1.6 to 6.8±0.2, p=0.030), and emotional function (4.2±1.9 to 6.6±0.5, p=0.014). FACIT–Fatigue increased (36.0±11.8 to 44.5±7.2, p=0.010), and SNOT–22 scores decreased markedly in patients with nasal polyposis. PROMIS–29 revealed reduced depression and fatigue, with improved physical functioning. Overall satisfaction with telepharmacy follow–up was 8.7/10. <h3>Conclusion and Relevance</h3> Telepharmacy enables efficient dual follow–up for severe asthma patients on biologics, providing real–time query resolution and outcome monitoring. Significant improvements were observed in pulmonary function, asthma control, HRQoL, and fatigue, alongside high patient satisfaction. Telepharmacy represents a valuable strategy for value–based care in severe asthma. <h3>References and/or Acknowledgements</h3> The authors thank the Asthma Multidisciplinary Unit and the Hospital Pharmacy Department for their support in the implementation of the telepharmacy model. No external funding was received. No conflict of interest