AbstractDigital twin (DT) technology provides accurate and real‐time visualization data. It is increasingly used in telemedicine to enhance medical efficiency and improve the precision of remote diagnosis and treatment. In telemedicine, DT is used to collect patients' biomedical data and transmit it to cloud servers through wearable devices for simulation, enabling remote diagnosis and treatment. However, telemedicine poses security threats due to the risk of medical data leaks. The security of medical data in transit and the authentication of communication entities are two key issues in cryptography. To address these issue, we propose a certificateless key agreement authentication scheme that does not rely on traditional public key infrastructure and certificate management, reducing the storage cost of resource‐limited wearable devices and avoiding the use of bilinear pairings to lower computational costs. Our scheme includes two parts of key agreement: one between the patient and the cloud server and the other between the patient and the hospital. Through these key agreements, we can ensure the privacy and integrity of medical data during transmission. Furthermore, we prove that the security of our scheme is equivalent to the elliptic curve discrete logarithm assumption in the random oracle model. Therefore, we provide a secure and efficient certificateless key agreement authentication solution that is suitable in digital twin telemedicine environments, particularly for client devices with limited functionality.