@mdramsey48 Hi there. My oncologist wanted me on either Besremi or Pegasys (peginterferon alfa-2a) but my insurance stated that I needed to try HU first. Once that didn't work, my oncologist sent over both the Besremi and the Pegasys. My insurance chose the Besremi. It was approved in 24 hours. I have read from others that it is pretty difficult to get on Besremi because it is so expensive. I would talk to your oncologist and your insurance to see if this drug they would approve. Also go to their website, they might have help for the cost. I started at 50mcg with Besremi then moved up to 100mcg stayed at that level for a couple of rounds of treatment and they just gradually kept upping the dose by 50mcgs. I am now on 300mcgs, and I have been on Besremi for over a year now. 300 seems to be my sweet spot. This treatment has made my life so much better. I tolerate it very well. Yes, I do get nausea at times, but I take a pill for that, and it goes away. Yes, I do still have exhaustion, fatigue, brain fog, some days are better than others, but I don't have pain from my MPN like I use to. I do get some flare ups ( I call them that) but it usually happens when I overdo myself or if I am coming down with something. If you go on Besremi I will say this, watch your mood because Besremi can cause extreme mood swings. You can be overly happy, hyper and then want to bite someone's head off, or be extremely depressed. I'm also on medication for depression/anxiety and since being on Besremi we have already had to switch up my medication for that. My oncologist has stressed to me that they can only try to treat the symptoms, the treatment is to help your quality of life and is not curative. I feel that it has helped the quality of my life, but I am also still very exhausted by the end of the day and there is still things that I can't do due to the exhaustion and fatigue I feel. Besremi like any other medication will affect everyone differently. I hope this answered your question and if you and your oncologist decide to go forward with this treatment, I hope that it does wonders for you.