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Therapeutic Use Exemptions (TUE)

Therapeutic Use Exemptions (TUEs)

What is a TUE?

Athletes may have illnesses or conditions that require them to take particular medications or to use particular methods of treatment. If the medication an Athlete is required to take to treat an illness or condition is included on the WADA Prohibited List, a Therapeutic Use Exemption (TUE) gives that Athlete the authorization to take the needed medicine so long as the Athlete fulfills all the mandatory criteria to do so.

The IPF processes all TUE applications in accordance with the International Standard for Therapeutic Use Exemptions (ISTUE).

When should I apply for a TUE?

You should apply for a TUE as soon as you are prescribed the medication, prior to using the medication.  For substances prohibited In-Competition only, you should apply for a TUE at least thirty (30) days before your next Competition, unless it is an emergency or exceptional situation.

NOTE: Some Major Event Organization may require that you apply for a TUE directly with them. If you are competing in a Major Event (multisport competition), make sure to verify the anti-doping rules for the competition.

What are the criteria you must fulfill in order to obtain a TUE?

The following 4 criteria must be met in order for a TUE to be granted (for more details, please refer to the WADA International Standard for Therapeutic Use Exemptions (ISTUE) Article 4.2):

  • The athlete would experience significant health problems without taking the prohibited substance or method;
  • The therapeutic use of the substance would not produce significant enhancement of performance;
  • There is no reasonable therapeutic alternative to the use of the otherwise prohibited substance or method;

The requirement to use that substance or method is not due to the prior use of the substance or method without a TUE which was prohibited at the time of use.
 

Who do I apply to for a TUE?

If you have been identified as International-Level Athlete,you must apply to the IPF for a TUE to be granted prior to the use of their medication.  If you already have a TUE granted by your National Anti-Doping Organization (NADO), you may request that the IPF recognize the TUE granted by your NADO.  Please send your TUE to the IPF TUEC  and copy IPF Anti-Doping.

If you are not an International-Level Athlete, you must apply to your National Anti-Doping Organization for a TUE. If the IPF chooses to collect a sample you (an athlete who is not an International-Level Athlete) and you are using a Prohibited Substance or Prohibited Method for therapeutic reasons, you will be allowed to apply for the IPF for a retroactive TUE if you do not already have one granted by your NADO.

You may only apply retroactively for a TUE to the IPF if:

  • You required emergency or urgent treatment of a medical condition.
  • There was insufficient time, opportunity or other exceptional circumstances that prevented you from submitting the TUE application, or having it evaluated, before getting tested.
  • You are a lower level athlete who is not under the jurisdiction of the IPF or NADO and were tested.
  • You tested positive after using a substance Out-of-Competition that is only prohibited In-Competition (for example glucocorticoids).

In rare and exceptional circumstances and notwithstanding any other provision in the ISTUE, you may apply for and be granted retroactive approval for a therapeutic use of a prohibited substance or method, if considering the purpose of the Code, it would be manifestly unfair not to grant a retroactive TUE.

This unique retroactive TUE will only be granted with the prior approval of WADA (and WADA may in its absolute discretion agree with or reject the IPF’s decision).

Important note:

Using a prohibited substance or method without a TUE could result in an Anti-Doping Rule Violation.

In case an application for a retroactive TUE is necessary following sample collection, you are strongly advised to have a medical file prepared and ready to submit for evaluation.

 

How can I apply for a TUE to the IPF ?

  1. Download the IPF TUE Application Form
  2. Complete the IPF TUE Application Form (signed by your physician) along with all evidence confirming the diagnosis.  This include:
  • comprehensive medical history
  • results of all relevant examinations
  • laboratory investigations
  • imaging studies
  • copies of the original reports or letters

 

Evidence should be as objective as possible in the clinical circumstances.

Your application must be submitted in English. The IPF will not be responsible for translation costs, if applicable.

3. Submit your application and relevant medical documentation to the IPF TUEC and copy IPF Anti-Doping

4. Once a TUE application has been duly received in proper form, the TUE application will be reviewed by at least 3 members of the IPF TUEC. Should the application form not be properly filled out, or should mandatory medical documentation be missing, you will be duly informed and your TUE application will not be accepted until adequately submitted.

5. A decision will be provided to you within 21 days of receiving your complete application.

6. If your TUE application or your request for recognition is denied by the IPF, you may appeal for a review of that decision before the WADA TUE Committee, in accordance with article 4.4.7 of the IPF Anti-Doping Rules

How do I request the TUE granted by my NADO to be recognized by the IPF?

If you have a TUE granted by your NADO, you can request for the IPF to recognize it two ways:

  1. Send your request to the IPF TUEC and copy IPF Anti-Doping.
  2. Ask your NADO to see if they can assist you with notifying the IPF of your request for recognition through ADAMS.

Does IPF automatically recognize TUEs granted by NADOs or other International Federations?

No.  The IPF will not automatically recognize TUEs granted by NADOs or other International Federations. If you have a TUE granted by your NADO or another International Federation, you must request that the IPF recognize it. 

The IPF will recognize TUEs granted by other Code Signatories (NADOs or International Federations) as long as the TUEs were processed according to the International Standard for Therapeutic Use Exemptions and the applications, supporting documentation and decisions are properly reported in ADAMS.

Your request for recognition should be submitted to the IPF TUEC and copy IPF Anti-Doping in writing quoting your ADAMS TUE reference number.

What if my NADOs TUE is not recognized by the IPF?

You and/or your NADO have 21 days from the date of decision to refer the matter to WADA for review.  The email address to enquire and/or send the request for review is: medical(at)wada-ama.org. Alternatively, you may send to:

WADA Medical Department
World Anti-Doping Agency
Stock Exchange Tower
800 Place Victoria (Suite 1700)
P.O. Box 120
Montreal (Quebec) H4Z 1B7
Canada

The same information that was provided to your NADO should be submitted to WADA.  Please use a secure on-line method unless sending by registered mail.

Pending WADA’s decision, your NADO TUE remains valid for national-level competition and out-of-competition testing only.

If the matter is not referred to WADA for review, your NADO must determine whether the original TUE that was granted should remain valid for national-level Competition and Out-of-Competition Testing.

What if my TUE application is denied?

A decision to deny a TUE application will include a written explanation of the reason(s) for the denial. If it is not clear to you, please contact IPF to understand exactly why the TUE was denied. Sometimes, there may be a critical piece of information, diagnostic test, laboratory results missing, etc. In which case, you should re-apply to us.

You and/or your NADO may refer the matter to WADA for review no later than 21 days after notification of the IPF TUEC decision. You should send the same information that you submitted to us, and on which the decision to deny the TUE was based on, via a secure on-line method or by registered mail at:

WADA Medical Department
World Anti-Doping Agency
Stock Exchange Tower
800 Place Victoria (Suite 1700)
P.O. Box 120
Montreal (Quebec) H4Z 1B7
Canada

The email address to enquire and/or send the request for review is: medical(at)wada-ama.org

It should be noted that WADA is not obliged to proceed with a request for a review. In that case, you and/or your NADO may appeal to the Court of Arbitration for Sport (CAS).

What if I need to renew my TUE?

Each TUE has a specific duration, at the end of which it expires automatically. Should you need to continue to use the prohibited substance or method, it is your responsibility to submit a new application for a TUE with updated medical information ahead of the expiry date, so that there is sufficient time for a decision to be made prior to the expiry of the current TUE.

Important note:

The presence (following sample collection), use, possession or administration of the prohibited substance or method must be consistent with the terms of your TUE. Therefore, if you require a materially different dosage, frequency, route or duration of administration, you should contact the IPF TUEC and copy IPF Anti-Doping, as you may be required to apply for a new TUE. Some substances and dosages, e.g. insulin, are often modified during treatment and these possible fluctuations should be mentioned by the treating physician in the TUE application and would usually be accepted by the ADO TUEC.

Will my medical information be treated in a confidential manner?

All the information contained in a TUE application, including the supporting medical information and any other information related to the evaluation of your TUE request is kept strictly confidential and treated in accordance with the Athlete’s Declaration contained in the ADAMS TUE process. All members of the TUEC and any other authorized recipients of your TUE request and related information (as described in the Athlete’s Declaration) are subject to a professional or contractual confidentiality obligation.

Please review the terms of the Athlete’s Declaration carefully. In particular, note that should you wish to revoke the right of the IPF’s TUEC to obtain the information related to your TUE in accordance with the Athlete’s Declaration, your TUE application will be deemed withdrawn without approval [or recognition] being granted.

Your TUE request-related information will be retained by the IPF and any other authorized recipients for no longer than necessary for the purposes stated in the Athlete’s Declaration, in accordance with the International Standard for the Protection of Privacy and Personal Information.

Contact information

For any further information and questions in relation to the IPF’s personal information practices, please contact the IPF’s Data Protection Officer. 

If you have a doubt as regards to which organization you should apply for a TUE, or as to the recognition process, or any other question about TUEs, please contact: the IPF TUEC and copy IPF Anti-Doping.

Other Useful Links

WADA International Standard for Therapeutic Use Exemptions (ISTUE)

WADA Q&A on Therapeutic Use Exemptions

WADA Checklists for TUE Applications

WADA Guidelines for the 2021 International Standard for Therapeutic Use Exemptions (ISTUE)

WADA Anti-Doping Education and Learning (ADEL)

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