U.S. Anti-Doping Agency (USADA)

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What Happens to My TUE?

In some situations, an athlete may have an illness or condition that requires the use of medication listed on the World Anti-Doping Agency’s Prohibited List. USADA can grant a Therapeutic Use Exemption (TUE) in these situations in compliance with the WADA International Standard for TUEs. The TUE application process is thorough and designed to balance the need to provide athletes access to critical medication while protecting the rights of clean athletes to compete on a level playing field.

The health and well-being of the athlete must always remain the priority. Consequently, while it is always preferable for athletes to apply in advance for a TUE, this is not always possible, especially when athletes require immediate or emergency medical treatment. The health and safety of the athlete is paramount, and no treatment should be withheld that would result in the athlete’s health being compromised.

Here’s what you need to know about the journey of a TUE, from the diagnosis to the TUE decision.

Diagnosis. An athlete with an injury or illness seeks medical advice from a physician or medical provider and receives a diagnosis with a recommendation for treatment. The athlete informs the medical provider of their anti-doping obligations. They both search the medication or method on Global DRO to determine the prohibited status in sport. If prohibited, alternative treatments identified as not prohibited on Global DRO are considered and either trialed or ruled out with cause.
Submission. The athlete submits a TUE Pre-Check Form to USADA with information about the prohibited treatment and receives a response within 3-5 business days advising if a TUE is required. The athlete follows the steps to submit a TUE application to USADA with all required medical information. A complete application includes all relevant information outlined in the WADA TUE Physician Guidelines and USADA Checklist.
Screening. The USADA TUE Team screens the application to determine if it is complete. Complete applications are forwarded for review to independent physicians with relevant medical expertise who are members of the USADA TUE Committee (TUEC). The athlete receives notice that their application has been forwarded to the TUEC. Incomplete applications will result in a letter being sent to the athlete with specific details of why the application is incomplete and cannot be assessed by the TUEC, along with a request to resubmit with the additional information.
Assessment. The TUEC assesses the medical information provided against the international standards to determine if there is a confirmed diagnosis that requires treatment with the prohibited medication/method, that there is no potential for enhanced performance beyond returning the athlete to a normal state of health, and that there are no other permitted alternatives appropriate to treat the athlete’s medical condition.
Decision. Decisions are provided as soon as possible, and usually within 21 days of receiving a complete application. If the TUEC requests more information, the process may take longer. If the TUE is approved, the athlete receives an approval letter and TUE certificate, at which time they have an active TUE. The TUE is also uploaded into WADA's global anti-doping system, ADAMS, which allows transparency for anti-doping organizations with testing jurisdiction over the athlete. If the TUE is denied, the athlete receives a letter outlining the reasons for the denial. In some cases, the athlete may reapply with medical information that addresses the reasons for the denial.

Need a TUE?

More questions?

Athletes and athlete support personnel can contact TUE@USADA.org with more questions about substances, methods, and TUEs.

Learn more about the Therapeutic Use Exemptions.

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