Background <p>Chronic rhinosinusitis with nasal polyps (CRSwNP) is often associated with type 2 inflammation and has significant impact on quality of life. Since 2019, biologics targeting type 2 pathways have been approved as add-on therapy for severe, treatment-refractory CRSwNP. However, the development of biologic prescribing patterns in Germany since their approval has not yet been systematically analyzed.</p> Methodology <p>Diagnosis and prescription data of all residents with statutory health insurance (SHI) in Germany were analyzed for 2019–2023. Patients diagnosed with chronic rhinosinusitis (CRS, ICD-10: J32 and/or J33) and CRSwNP (ICD-10: J32 and J33) treated ENT specialists were included. We assessed case numbers, biologic prescriptions (Dupilumab, Omalizumab, Mepolizumab), biologic-treated patients per physician, and proportions among CRS/CRSwNP patients. Demographic variables (age, sex, residence) were also analyzed.</p> Results <p>CRS and CRSwNP case numbers declined in 2020 but increased thereafter. Biologic prescriptions rose from &lt; 0.1% in 2019 to ~ 5% of CRSwNP patients in 2023. Biologic-treated patients per physician increased from 2.59 to 13.34 (SD: 19.78) in CRSwNP and from 3.78 to 18.41 (SD: 27.09) in CRS. Omalizumab was most prescribed in 2019 (55%), but Dupilumab dominated from 2020 onward (86–94%). Mepolizumab use rose to 5–10% in 2022–2023. Biologic-treated patients were younger than those without (53.2 vs. 56.1 years; <i>p</i> &lt; 0.001). Rural patients had slightly higher CRSwNP prevalence but lower biologic use.</p> Conclusions <p>Biologic use in CRSwNP increased substantially. Age and regional differences suggest disparities in access or prescribing patterns.</p>