Cook the pasta. Bring a large pot of salted water to a boil and cook the pasta until al dente according to the package instructions.
Before draining, save about 1/2 cup of the pasta water.
Blend the roasted peppers. Add the roasted red peppers to a blender or food processor and blend until smooth. If you like a little texture, you can leave it slightly chunky.
Sauté the garlic. Warm the olive oil and butter in a large skillet over medium heat. Add the minced garlic and cook for about 30 seconds, just until fragrant.
Add the pepper puree. Stir the blended roasted peppers into the skillet and cook for 2 to 3 minutes.
This helps deepen the flavor and removes any raw taste.
Build the sauce. Pour in the heavy cream and milk, then add the salt, black pepper, red pepper flakes if using, and Italian seasoning. Stir and let the sauce warm through without boiling.
Melt in the cheese. Reduce the heat to low and slowly stir in the Parmesan cheese. Keep stirring until the sauce turns smooth and creamy.
Adjust the texture. If the sauce feels too thick, add a little reserved pasta water.
This helps the sauce loosen up and cling to the pasta better.
Combine everything. Add the drained pasta to the skillet and toss until every piece is coated in the sauce. Let it sit for a minute so the pasta absorbs some of the flavor.
Finish and serve. Top with fresh basil or parsley and a little extra Parmesan if you want. Serve it warm right away for the best texture and flavor.