Anti-doping - TUE
THERAPEUTIC USE EXEMPTIONS (TUEs)
TUE application form
Athletes may have an illness or medical condition that requires a particular medication. If this medication contains a banned substance (one that appears on the WADA Prohibited List), they may need to apply for a Therapeutic Use Exemption (TUE). This gives the athlete an exemption to take the medication, while competing in sport.
Any athlete who may be subject to testing (doping control) must obtain a TUE if they are taking a prohibited substance or using a prohibited method.
A TUE application should be submitted as soon as possible. For substances banned in-competition only, athletes should apply for a TUE at least 30 days before their next competition, unless it is an emergency or exceptional situation. In such cases, a TUE may be applied for retroactively.
IMPORTANT: It is the athlete’s responsibility to find out if any medication they want to take contains a banned substance (on the WADA Prohibited List).
If an athlete is being prescribed a medication or undergoing a medical procedure, they must ask their doctor if it involves any banned substances. Where a banned substance is involved, the doctor should then assess if there is an alternative medication (or procedure) that can be administered that does not contain a banned substance. If there is no suitable alternative, the athlete must apply for a TUE.
For more information about TUEs read the World Anti-Doping Agency's Frequently Asked Questions (FAQ) on TUEs.
IPC's Role in the TUE Process
The IPC operates both as a Major Event Organisation (MEO) and an International Federation (IF).
As the MEO for major multi-sport events such as the Paralympic Games, the IPC manages the TUE approval process for all participating athletes.
The IPC functions as an IF for the World Para sports listed below:
|World Para Athletics||World Para Powerlifting|
|World Para Dance Sport||World Shooting Para Sport|
|World Para Ice Hockey||World Para Swimming|
Where to Apply for a TUE
Where (and when) an athlete must apply for a TUE depends on their status as a national or international level athlete.
National Level Athletes
National Level Athletes must apply to their National Anti-Doping Organisation (NADO) for a TUE before taking the medication. Athletes should contact their NADO for advice if unsure of their status and about the application process.
International Level Athletes
The IPC receives and processes TUE applications from International Level athletes for the IPC Para sports for which it is the IF. Each of the sports publishes annually a list which outlines who is considered an International Level Athlete - click on the links above to go to the sport specific Anti-Doping page where the International Level Athlete criteria are published.
Athletes who are included on the International Level Athletes list must apply to the IPC for a TUE: email@example.com
If an athlete does not meet the IPC's International Level Athlete criteria, they should contact their NADO to confirm their status and requirements regarding TUEs.
Athletes who are neither National nor International Level Athletes are not required to apply for a TUE unless they return a positive test. In this situation, a retroactive application must still meet all the requirements for approval.
TUE Application Process
Athletes are required to submit a completed and signed TUE application form to the IPC. TUE applications can be submitted via ADAMS or by email to: firstname.lastname@example.org
The TUE application must be submitted in legible capital letters or typing. The medical file must include:
• A comprehensive medical history, including documentation from the original diagnosing physician(s) (where possible);
• The results of all examinations, laboratory investigations and imaging studies relevant to the application;
• Copies of original reports, letters and specialist reviews;
• A detailed summary of any alternative medications tried (including names, dosages, duration of use, and effects) or clinical justification from the prescribing doctor that confirms that in their opinion there are no other reasonable permitted alternatives that exist to treat the medical condition.
Any cost incurred for the completion of a TUE application is at the responsibility of the Athlete, including any required additional medical examinations, tests and imaging studies.
Any TUE application that is not complete or legible will not be dealt with and will be returned for completion and re-submission.
To assist the athlete and their doctor in providing the correct medical documentation, we suggest consulting WADA’s Checklists for TUE applications for guidance and support, and the Medical Information to Support the Decisions of TUEs for guidance on specific common medical conditions, treatments, substances, etc.
The athlete should keep a complete copy of the TUE application form and all medical information submitted in support of the application, and proof that it has been sent.
TUE Application Checklists
• Attention Deficit Hyperactivity Disorder (ADHD)
• Adrenal Insufficiency
• Cardiovascular Conditions
• Inflammatory Bowel Disease
• Intravenous Infusions
• Male Hypogonadism
• Musculoskeletal Conditions
• Neuropathic Pain
• Renal Transplantation
• Intrinsic Sleep Disorders
• Transgender Athletes
How do I know if my application has been approved
If a TUE has been approved, the athlete will receive confirmation from the IPC and a certificate will be issued. If any of the conditions outlined in the TUE certificate such as dosage, frequency, route of administration and duration for use of the medication should change, the athlete must inform the IPC.
If a TUE is not granted, athletes can ask WADA to review the application or appeal in line with the relevant IPC's Anti-Doping rules.
If a TUE is not granted during a Major Event such as the Paralympic Games the athlete may appeal the decision to the TUE tribunal in line with the relevant IPC Anti-Doping rules.
Renewing an Existing TUE
TUEs are only approved for a specific period of time and will eventually expire. It is the athlete's responsibility to renew the TUE, if required, before it expires. A new TUE application form needs to be completed and submitted, together with a new medical report confirming the diagnosis and the outcome of any further investigations conducted (since the previous application).
Recognising Existing TUEs
When an athlete has a TUE issued by its National Anti-Doping Organisation (NADO) it is only valid at the national level. When competing internationally, the NADO TUE needs to be submitted to the responsible IF for recognition – or in the case of a major event, the TUE needs to be sent to the responsible MEO for recognition.
An athlete who has received a TUE from her/his NADO, must submit a request for recognition of the TUE in writing to the IPC (email@example.com) quoting the ADAMs TUE reference number. The National Anti-Doping Organisation (NADO) that approved the TUE needs to make the TUE and supporting materials available to the IPC via ADAMS to enable the IPC to access it.
The IPC will only recognise TUEs that are recorded in ADAMS.
Note: TUE recognition by the IPC remains subject to Article 126.96.36.199 of the 2021 World Anti-Doping Code, which requires that “the TUE meets the criteria set out in the International Standard for Therapeutic Use Exemptions”. The IPC may request extra supporting documentation.
Therefore, the IPC will recognise TUEs as follows:
TUEs issued by NADOs and IFs listed below will be eligible for automatic recognition, EXCEPT for TUEs for the following substances, which will require review by the IPC TUE Committee:
S0. Non-Approved Substances
S1: Anabolic Agents
S2: Peptide Hormones, Growth Factors, Related Substances and Mimetics
Prohibited Methods: M1, M2 and M3.
P.1 Beta-Blockers in World Shooting Para Sport only
The IPC’s intention is to automatically recognise Therapeutic Use Exemptions (TUEs) from as many National Anti-Doping Organisations (NADOs) and International Federations (IFs) as possible. Unfortunately, at this time, the IPC does not have enough information on many NADOs and IF’s TUE Committees and their processes to make that decision.
If a NADO or IF wishes to be included on the automatic recognition list below, please submit applicable information to firstname.lastname@example.org and we will gladly review this information.