@jeanette1954 From information I’ve gleaned over time, from my understanding HU can help to control the over production of red blood cells in PV. But it doesn’t target the mutated JAK2 Gene. Whereas Besremi may help shut down the overactive gene and is considered a potential disease-modifying treatment.

Digging through my materials I found this article. I’m not sure how credible a source it is but the information correlates with other articles I’ve read. This one from Linked-in actually compares 3 medications other than Hydroxurea. If for nothing else it will give you an overview of other treatments.
https://www.linkedin.com/pulse/exploring-future-polycythemia-vera-treatments-besremi-himanshu-mason-14p3e
We also have other members in Connect who have had questions about switching to Besremi. @eferret posted this discussion a couple of years ago.

~After 3 months on hydroxyurea, I am going to ask to switch to Besremi
https://connect.mayoclinic.org/discussion/after-3-months-on-hydroxyurea-i-am-going-to-ask-to-switch-to-besremi/
You might want to read through the conversations and tag members there.

Have you discussed the possibility of changing meds with your doctor?