TUE

Therapeutic Use Exemptions

Requirements to Apply a TUE

What is a Therapeutic Use exemption (TUE)?

Some athletes may have illnesses or conditions that require them to take medications or undergo procedures. If the medication or method an athlete is required to use to treat an illness or condition is prohibited as per the World Anti-Doping Agency’s (WADA) Prohibited List a TUE may give that athlete the authorization to use that substance or method while competing without invoking an anti-doping rule violation (ADRV) and applicable sanction. Applications for TUEs are evaluated by a panel of physicians, the TUE Committee (TUEC).

PAN-RADO TUEs are only valid for national-level Competition and Out-of-Competition Testing.

What are the criteria for granting a TUE?

The athlete has a clear diagnosed medical condition which requires treatment using a prohibited substance or method.
The therapeutic use of the substance will not, on the balance of probabilities produce significant enhancement of performance beyond the athlete’s normal state of health.
The prohibited substance or method is an indicated treatment for the medical condition, and there is no reasonable permitted therapeutic alternative.
The necessity to use that substance or method is not a consequence of the prior use (without a TUE), of a substance or method which was prohibited at the time of use.

Who should apply for a TUE? Where and when to apply?

Athletes who are subject to anti-doping rules would need a TUE to take a prohibited substance or use a prohibited method should verify with PAN-RADO to know to whom you need to apply and if you can apply retroactively.

First, check if the required medication or method you intend to take, or use is prohibited as per the WADA Prohibited List.

You have a responsibility to inform your physician(s) that you are an Athlete bound to anti-doping rules. You and your physician(s) should check the Prohibited List for the substance/method you are prescribed. If the substance/method is prohibited, discuss non-prohibited alternatives, if there are none, apply for a TUE. Remember Athletes have the ultimate responsibility. Contact PAN-RADO if you are having difficulties.

Then, contact PAN-RADO to determine your competition level and TUE application requirements.

National Level Athlete

If it is determined that you are an International-Level Athlete you must apply to PAN-RADO in advance, as soon as the need arises, unless there are emergency or exceptional circumstances.

For substances prohibited in-competition only, you should apply for a TUE at least 30 days before your next competition, unless one of the exceptions on retroactive TUEs (see below) apply.

Under National Level Athlete

If you are NOT a National-Level Athlete and you have been tested by PAN-RADO or any other NADO, you must apply for a retroactive TUE to PAN-RADO.

*National Athlete: any person who competes in sport at the international level (as defined by each International Federation) or at the national level (as defined by each National Anti-Doping Organization)

The TUEs granted by the PAN-RADO are valid only at the national level. If you are or become an International Level Athlete, or participate in major competitions, that TUE will not be valid unless recognized by the relevant International Federation (IF) or Major Event Organization (MEO).

It is your responsibility to check if the TUE issued by the PAN-RADO is automatically recognized by the FI or MEO.

The PAN-RADO can help you determine your level and with the application requirements for a TUE, and if necessary, to present the TUE to an FI or MEO for recognition. For more information contact aut@orad-pan.org

Can I get a retroactive TUE?

You may only apply retroactively for a TUE to PAN-RADO 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.
Under the PAN-RADO anti-doping rules you were not allowed or required to apply for a TUE in advance.
You are a lower level athlete who is not under the jurisdiction of an IF or PAN-RADO 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 PAN-RADO’s decision).

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.

Application process to obtain a TUE

There are two ways you can request your TUE. The recommended is through the ADAMS System, using your username and password. If you do not have them, you can request them at adams@orad-pan.org. The second way is through a form, following the instructions below:

1

Download the general TUE form by clicking on the button or select a specific TUE from the list at the bottom of tha page.

2

Ask your doctor to fill the TUE form, in Legible Capital Letters or typed, and send it along with your medical record to aut@orad-pan.org

3

Once a TUE is requested, a panel of experts selected by the PAN-RADO will review your request and grant the TUE if:

Your health could be significantly affected if you do not take this substance.
The substance does not increase your performance and only allows you to regain your health.
There are no other alternative treatments available.
The need to use the substance or method is not due to the prior use of the substance or method without a valid TUE

4

The PAN-RADO will notify you whether or not you can take the requested medication. In the event of a denied request, you will be informed of the reasons. You have the right to appeal the decision.

The medical file most include:

Further recomendations

To assist you and your doctor in providing the correct medical documentation, we suggest consulting the WADA’s Checklists for TUE applications for guidance and support during the TUE application process, and Checklists for TUE applications for guidance on specific common medical conditions, treatments, substances, etc.

Keep a complete copy of the TUE application form and all medical information submitted in support of your application, and proof that it has been sent.

What happens at major events?

A Major Event Organization (MEO) requires athletes to apply for the recognition of their TUE if they wish to use a prohibited substance or method in connection with the Event.

If you have a TUE granted by PAN-RADO and you will be competing at a Major Event e.g., the Olympic Games, you should contact the MEO for information on their recognition process.

When will I receive a decision on my TUE application [or request for recognition]?

PAN-RADO’s TUEC’s must render a decision as soon as possible, and usually within 21 days from the date of receipt of the complete TUE application [or request for recognition].

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.

Remember that 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 PAN-RADO, 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.

What if my PAN-RADO’s 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 PAN-RADO 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.

What if my PAN-RADO’s tue is not recognized by my IF?

PAN-RADO has 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@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 PAN-RADO should be submitted to WADA. Please use a secure on-line method unless sending by registered mail.

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

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

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 PAN-RADO’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 PAN-RADO 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.

TUE checklists

WADA has produced a series of TUE checklists to provide guidance and support to athletes, their physicians, and national anti-doping organizations during the TUE process.

These checklists are based on WADA published guidelines for physicians, cover the most common conditions, and describe the requirements for completing TUE forms, including the medical evidence that must be submitted along with the forms.

TUE