Font size bigger Font size smaller

THERAPEUTIC USE EXEMPTIONS (TUE)

Occasionally, athletes may have to take medication that contains a substance on the Prohibited List, to treat an illness or condition.  Before taking the medication, they must apply for, and have a Therapeutic Use Exemption (TUE) approved by an Anti-Doping Organisation, which may give them the authorisation to take the needed medicine.

It is important to remember that it is the athlete’s responsibility to find out if any medication they take, to treat an illness or condition, does contain a substance on the WADA Prohibited List. National and International Level athletes must apply for a TUE BEFORE taking the medication (except in a medical emergency).

So if an athlete is prescribed a medication, or is undergoing a medical procedure, they must check with their doctor as to whether it involves any substances that are on the Prohibited List.  If the medication/procedure contains a banned substance, the doctor should assess whether there is an alternative medication or procedure (that does not contain a banned substance) that can be used instead.  If there is no suitable alternative medication, a TUE should be applied for.

World Anti-Doping Agency (WADA) Frequently Asked Questions (FAQ) on TUEs

The IPC & TUEs

The IPC functions both as an International Federation (IF) and a Major Event Organisation (MEO).

As an IF, the IPC processes TUEs for the following World Para Sports:

World Para Alpine Skiing

World Para Athletics

World Para Dance Sport

World Para Ice Hockey

World Para Nordic Skiing

World Para Powerlifting

World Shooting Para Sport

World Para Snowboard

World Para Swimming

Further information on how to apply for a TUE can also be found on the respective World Para Sport Anti-Doping pages.

The IPC functions as the MEO for some multi-sport competitions such as the Paralympic Games.

Where to apply for a TUE

National Level Athletes

If you are a national level athlete, you apply to your National Anti-Doping Organisation (NADO). Contact your NADO, if you’re unsure about your national status.

International Level Athletes (ILA)

Athletes who have been identified as International Level Athletes, need to apply to the IPC for their Therapeutic Use exemption for the below listed sports.

A full name list of International Level Athletes in each IPC World Para Sport that are required to apply for a TUE to the IPC can be found on the respective World Para Sport anti-doping webpage:

World Para Alpine Skiing

World Para Athletics

World Para Dance Sport

World Para Ice Hockey

World Para Nordic Skiing

World Para Powerlifting

World Shooting Para Sport

World Para Snowboard

World Para Swimming

If you are not in the above list, you need to apply to your NADO.

TUE application process

Athletes are required to submit a completed TUE application form with the support of their medical doctor.

An application will only be considered when submitted alongside the following supporting medical evidence:

  • Comprehensive medical history and the results of all relevant examinations, laboratory investigations and imaging studies.
  • 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.
  • TUE Application form 

New applications can be submitted via ADAMS or send via email to: TUE@paralympic.org

Athletes that already have a valid TUE

If you have a TUE from your NADO, it is not valid when competing at the international level unless it is recognised by the IF – or in the case of a major event, is recognised by the Major Event Organisation.

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.

Therefore, the IPC will automatically recognise TUEs as follows:

TUEs issued by NADOs and IFs listed below will be eligible for automatic recognition.

This is always subject to the requirement of 2021 World Anti-Doping Code Article 4.4.3.1 that “the TUE meets the criteria set out in the International Standard for Therapeutic Use Exemptions.”

For these NADOs and IFs, all substances will be automatically recognised EXCEPT for the following, 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

S.8 Cannabinoids

Meldonium

Prohibited Methods: M1, M2 and M3.

P.1 Beta-Blockers in World Shooting Para Sport only.


In order to best serve athletes, the IPC would like to grow this list with time and as the capacity for TUE processing is enhanced. We are open to hearing from your NADO or IF as to why you should be included on the automatically recognised NADO or IF list. Please submit any applicable information to tue@paralympic.org and we will gladly review this information.

An athlete who has received a TUE from her/his National Anti-Doping Organisation, needs to submit a request for recognition of the TUE by the IPC. This can be done by requesting your Anti-Doping Organisation that granted the TUE to make the TUE and supporting materials available via ADAMS to the IPC.

The IPC will only recognise TUEs that are recorded in ADAMS. The IPC may request extra supporting documentation.

TUE Renewal

Once a TUE has been approved, it is the responsibility of each athlete to renew their TUEs upon expiry, if necessary.

Checklists for Therapeutic Use Exemption (TUE) Applications

The following TUE checklists were designed by the World Anti-Doping Agency (WADA) to provide guidance and support to athletes, their physicians and Anti-Doping Organisations (ADOs) during the TUE application process:

International Federation List – Automatic Recognition

  1. Badminton World Federation (BWF)
  2. Boccia International Sports Federation (BISFed)
  3. Cerebral Palsy International Sports and recreation Association (CPIRSA)
  4. International Blind Sport Federation (IBSA)
  5. International Canoe Federation (ICF)
  6. International Cycling Union (UCI)
  7. International Equestrian Federation (FEI)
  8. International Federation of Cerebral Palsy Football (IFCPF)
  9. World Rowing Federation (FISA)
  10. International Table Tennis Federation (ITTF)
  11. International Tennis Federation (ITF)
  12. International Triathlon Union (ITU)
  13. International Wheelchair and Amputee Sport Federation (IWAS)
  14. International Wheelchair Basketball Federation (IWBF)
  15. International Wheelchair Rugby federation
  16. World Archery (WA) (In addition to the above list, TUEs granted for the use of a beta-blocker (P2) are not eligible for automatic recognition)
  17. World Curling Federation (WCF)
  18. World Para Volley (WPV)
  19. World Taekwondo (WT)

NADO List – Automatic Recognition (Countries)

  1. Australia: Australian Sports Anti-Doping Authority (ASADA)
  2. Austria: Nationale Anti-Doping Agentur Austria (NADA)
  3. Azerbaijan: Azerbaijan National Anti-doping Agency
  4. Belgium: (Flanders): NADO Flanders
  5. Belgium: (French Community): French Community NADO
  6. Bermuda: Bermuda Sport Anti-Doping Authority
  7. Brazil: Autoridade Brasileira de Controle de Dopagem (ABCD)
  8. Canada: Canadian Centre for Ethics in Sport (CCES)
  9. China: China Anti-Doping Agency (CHINADA)
  10. Colombia: COLDEPORTES (COL-NADO)
  11. Croatia: Croatian Institute of Public Health
  12. Czech Republic: Anti-Doping Committee of the Czech Republic
  13. Denmark: Anti-Doping Denmark (ADD)
  14. Finland: Finnish Center for Integrity in Sports
  15. France: Agence française de lutte contre le dopage
  16. Georgia: Georgian Anti-Doping Agency
  17. Germany: Nationale Anti-Doping Agentur (NADA)
  18. Greece: Hellenic National Council for Combating Doping (ESKAN)
  19. Hungary: Hungarian Anti-Doping Group (HUNADO)
  20. Ireland: Sport Ireland
  21. Italy: NADO-Italia
  22. Japan: Japan Anti-Doping Agency
  23. Kazakhstan: Kazakhstan National Anti-Doping Organization
  24. Kenya: Anti-Doping Agency of Kenya
  25. Korea: Korea Anti-Doping Agency (KADA)
  26. Latvia: Anti-Doping Bureau of Latvia
  27. Lithuania: Anti-Doping Agency of Lithuania
  28. Luxembourg: Agence luxembourgeoise antidopage (ALAD)
  29. Netherlands: Doping autoriteit – Doping Authority Netherlands
  30. New Zealand: Drug Free Sport NZ
  31. Norway: Anti-Doping Norway
  32. Peru: Comisión Nacional Antidopaje del Peru
  33. Poland: Polish Anti-Doping Agency (POLADA)
  34. Portugal: Autoridade Antidopagem de Portugal (ADoP)
  35. Romania: National Anti-Doping Agency of Romania
  36. Russia: Russian Anti-Doping Agency 'RUSADA'
  37. Serbia: Antidoping Agency of Serbia (ADAS)
  38. Singapore: Anti-Doping Singapore
  39. Slovakia: Slovak Anti-Doping Agency (SADA)
  40. Slovenia: Slovenian Anti-Doping Organisation (SLOADO)
  41. South Africa: South African Institute for Drug Free Sport (SAIDS)
  42. Spain: Agencia Española de Protección de la Salud en el Deporte (AEPSAD)
  43. Sweden: Swedish Sports Confederation
  44. Switzerland: Antidoping Switzerland
  45. Tunisia: Agence nationale antidopage (ANAD)
  46. Turkey: Turkish Anti-Doping Commission
  47. United Kingdom: UK Anti-Doping
  48. United States of America: US Anti-Doping Agency (USADA)
  49. Uruguay: Organización Nacional Antidopaje del Uruguay (URU-NADO)