I started with symptoms of Orthostatic Hypotension (OH) and extreme fatigue at age 11. I am now 69 and was finally - 6 weeks ago - diagnosed for Primary Autonomic Failure. My doctor prescribed pyridostigmine for my OH but the insurance (Medicare/Silverscript/CVS) refused to pay for it saying that OH is not a disease. I guess that if he had written it for PAF they may have said "this is not a curable or treatable disease" and therefore deny it, too. There are too few PAF patients around to ask if they have a similar experience. Therefore, I ask if you would be able to tell me why this happens?