International Standard for Therapeutic Use Exemptions
The World Anti-Doping Code International Standard for Therapeutic Use
Exemptions (ISTUE) is a mandatory International Standard developed as partof the World Anti-Doping Program.
The International Standard for Therapeutic Use Exemptions was first adopted
in 2004 and came into effect 1 January 2005. Further revisions were made in2009, 2010, 2011, 2015, and 2018. The enclosed ISTUE incorporates revisions
approved by the WADA Executive Committee on 20 September 2018. It will
come into effect on 1 January 2019.
The official text of the International Standard for Therapeutic Use Exemptions
shall be maintained by WADA and shall be published in English and French. In
the event of any conflict between the English and French versions, the English
version shall prevail.

Published by:World Anti-Doping Agency
Stock Exchange Tower8
800 Place Victoria (Suite 1700)
PO Box 120
Montreal, Quebec
Canada H4Z 1B7
URL: www.wada-ama.org
Tel:
Fax:
E-mail:+ 1 514 904 9232
+ 1 514 904 8650
code@wada-ama.org

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TABLE OF CONTENTSPART ONE: INTRODUCTION, CODE PROVISIONS AND DEFINITIONS ............................................................. 4
1.0

Introduction and Scope .................................................................................................................................. 4

2.0

Code Provisions............................................................................................................................................. 4

3.0

Definitions and Interpretation ......................................................................................................................... 7

PART TWO: STANDARDS and Process FOR GRANTING TUEs ....................................................................... 11
4.0

Obtaining a TUE .......................................................................................................................................... 11

5.0

TUE Responsibilities of Anti-Doping Organizations .................................................................................... 12

6.0

TUE Application Process ............................................................................................................................. 14

7.0

TUE Recognition Process ........................................................................................................................... 16

8.0

Review of TUE Decisions by WADA ........................................................................................................... 17

9.0

Confidentiality of Information ....................................................................................................................... 18

ANNEX 1: Code Article 4.4 Flow-Chart ................................................................................................................ 20

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PART ONE: INTRODUCTION, CODE PROVISIONS AND DEFINITIONS
1.0

Introduction and Scope
The International Standard for Therapeutic Use Exemptions is a mandatory International Standard
developed as part of the World Anti-Doping Program.
The purpose of the International Standard for Therapeutic Use Exemptions is to establish (a) the
conditions that must be satisfied in order for a Therapeutic Use Exemption (or TUE) to be granted,
permitting the presence of a Prohibited Substance in an Athlete’s Sample or the Athlete’s Use or
Attempted Use, Possession and/or Administration or Attempted Administration of a Prohibited
Substance or Prohibited Method for therapeutic reasons; (b) the responsibilities imposed on AntiDoping Organizations in making and communicating TUE decisions; (c) the process for an Athlete
to apply for a TUE; (d) the process for an Athlete to get a TUE granted by one Anti-Doping
Organization recognized by another Anti-Doping Organization; (e) the process for WADA to review
TUE decisions; and (f) the strict confidentiality provisions that apply to the TUE process.
Terms used in this International Standard that are defined terms from the Code are written in italics.
Terms that are defined in this International Standard are underlined.

2.0

Code Provisions
The following articles in the 2015 Code are directly relevant to the International Standard for
Therapeutic Use Exemptions:
Code Article 4.4

Therapeutic Use Exemptions ("TUEs").

4.4.1

The presence of a Prohibited Substance or its Metabolites or Markers, and/or the Use or
Attempted Use, Possession or Administration or Attempted Administration of a Prohibited
Substance or Prohibited Method shall not be considered an anti-doping rule violation if it isconsistent with the provisions of a TUE granted in accordance with the International
Standard for Therapeutic Use Exemptions.

4.4.2

An Athlete who is not an International-Level Athlete should apply to his or her National AntiDoping Organization for a TUE. If the National Anti-Doping Organization denies theapplication, the Athlete may appeal exclusively to the national-level appeal body describedin Articles 13.2.2 and 13.2.3.

4.4.3

An Athlete who is an International-Level Athlete should apply to his or her International
Federation.
4.4.3.1

Where the Athlete already has a TUE granted by his or her National Anti-Doping
Organization for the substance or method in question, if that TUE meets the criteria
set out in the International Standard for Therapeutic Use Exemptions, then theInternational Federation must recognize it. If the International Federation considers
that the TUE does not meet those criteria and so refuses to recognize it, it must
notify the Athlete and his or her National Anti-Doping Organization promptly, withreasons. The Athlete or the National Anti-Doping Organization shall have 21 days
from such notification to refer the matter to WADA for review. If the matter isreferred to WADA for review, the TUE granted by the National Anti-Doping

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Organization remains valid for national-level Competition and Out-of-Competition
Testing (but is not valid for international-level Competition) pending WADA’s
decision. If the matter is not referred to WADA for review, the TUE becomes invalid
for any purpose when the 21-day review deadline expires.
4.4.3.2

If the Athlete does not already have a TUE granted by his or her National AntiDoping Organization for the substance or method in question, the Athlete must
apply directly to his or her International Federation for a TUE as soon as the needarises. If the International Federation (or the National Anti-Doping Organization,
where it has agreed to consider the application on behalf of the International
Federation) denies the Athlete’s application, it must notify the Athlete promptly,
with reasons. If the International Federation grants the Athlete’s application, it must
notify not only the Athlete but also his or her National Anti-Doping Organization,and if the National Anti-Doping Organization considers that the TUE does not meetthe criteria set out in the International Standard for Therapeutic Use Exemptions,
it has 21 days from such notification to refer the matter to WADA for review. If the
National Anti-Doping Organization refers the matter to WADA for review, the TUE
granted by the International Federation remains valid for international-level
Competition and Out-of-Competition Testing (but is not valid for national-level
Competition) pending WADA’s decision. If the National Anti-Doping Organization
does not refer the matter to WADA for review, the TUE granted by the International
Federation becomes valid for national-level Competition as well when the 21-day
review deadline expires.
[Comment to Article 4.4.3: If the International Federation refuses to recognize a
TUE granted by a National Anti-Doping Organization only because medical
records or other information are missing that are needed to demonstratesatisfaction with the criteria in the International Standard for Therapeutic Use
Exemptions, the matter should not be referred to WADA. Instead, the file should
be completed and re-submitted to the International Federation.
If an International Federation chooses to test an Athlete who is not an InternationalLevel Athlete, it must recognize a TUE granted to that Athlete by his or her National
Anti-Doping Organization.]

4.4.4

A Major Event Organization may require Athletes to apply to it for a TUE if they wish to Use
a Prohibited Substance or a Prohibited Method in connection with the Event. In that case:
4.4.4.1

The Major Event Organization must ensure a process is available for an Athlete toapply for a TUE if he or she does not already have one. If the TUE is granted, it iseffective for its Event only.

4.4.4.2

Where the Athlete already has a TUE granted by his or her National Anti-Doping
Organization or International Federation, if that TUE meets the criteria set out in
the International Standard for Therapeutic Use Exemptions, the Major Event
Organization must recognize it. If the Major Event Organization decides the TUE
does not meet those criteria and so refuses to recognize it, it must notify the Athlete
promptly, explaining its reasons.

4.4.4.3

A decision by a Major Event Organization not to recognize or not to grant a TUE
may be appealed by the Athlete exclusively to an independent body established or
appointed by the Major Event Organization for that purpose. If the Athlete does notappeal (or the appeal is unsuccessful), he or she may not Use the substance or

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method in question in connection with the Event, but any TUE granted by his or
her National Anti-Doping Organization or International Federation for that
substance or method remains valid outside of that Event.
[Comment to Article 4.4.4.3: For example, the CAS Ad Hoc Division or a similar
body may act as the independent appeal body for particular Events, or WADA may
agree to perform that function. If neither CAS nor WADA are performing thatfunction, WADA retains the right (but not the obligation) to review the TUE
decisions made in connection with the Event at any time, in accordance with Article
4.4.6.]
4.4.5

If an Anti-Doping Organization chooses to collect a Sample from a Person who is not anInternational-Level or National-Level Athlete, and that Person is Using a Prohibited
Substance or Prohibited Method for therapeutic reasons, the Anti-Doping Organization may
permit him or her to apply for a retroactive TUE.

4.4.6

WADA must review an International Federation’s decision not to recognize a TUE grantedby the National Anti-Doping Organization that is referred to it by the Athlete or the Athlete’s
National Anti-Doping Organization. In addition, WADA must review an International
Federation’s decision to grant a TUE that is referred to it by the Athlete’s National AntiDoping Organization. WADA may review any other TUE decisions at any time, whether uponrequest by those affected or on its own initiative. If the TUE decision being reviewed meetsthe criteria set out in the International Standard for Therapeutic Use Exemptions, WADA will
not interfere with it. If the TUE decision does not meet those criteria, WADA will reverse it.
[Comment to Article 4.4.6: WADA shall be entitled to charge a fee to cover the costs of (a)any review it is required to conduct in accordance with Article 4.4.6; and (b) any review itchooses to conduct, where the decision being reviewed is reversed.]

4.4.7

Any TUE decision by an International Federation (or by a National Anti-Doping Organization
where it has agreed to consider the application on behalf of an International Federation) thatis not reviewed by WADA, or that is reviewed by WADA but is not reversed upon review,
may be appealed by the Athlete and/or the Athlete’s National Anti-Doping Organization,
exclusively to CAS.
[Comment to Article 4.4.7: In such cases, the decision being appealed is the International
Federation’s TUE decision, not WADA’s decision not to review the TUE decision or (having
reviewed it) not to reverse the TUE decision. However, the time to appeal the TUE decision
does not begin to run until the date that WADA communicates its decision. In any event,whether the decision has been reviewed by WADA or not, WADA shall be given notice of
the appeal so that it may participate if it sees fit.]

4.4.8

A decision by WADA to reverse a TUE decision may be appealed by the Athlete, theNational Anti-Doping Organization and/or the International Federation affected, exclusively
to CAS.

4.4.9

A failure to take action within a reasonable time on a properly submitted application for
grant/recognition of a TUE or for review of a TUE decision shall be considered a denial of
the application.

Code Article 13.4

Appeals relating to TUEs

TUE decisions may be appealed exclusively as provided in Article 4.4.
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3.0

Definitions and Interpretation
3.1

Defined terms from the 2015 Code that are used in the International Standard for Therapeutic
Use Exemptions:
ADAMS: The Anti-Doping Administration and Management System is a Web-based databasemanagement tool for data entry, storage, sharing, and reporting designed to assist
stakeholders and WADA in their anti-doping operations in conjunction with data protection
legislation.
Administration: Providing, supplying, supervising, facilitating, or otherwise participating in
the Use or Attempted Use by another Person of a Prohibited Substance or Prohibited Method.
However, this definition shall not include the actions of bona fide medical personnel involving
a Prohibited Substance or Prohibited Method used for genuine and legal therapeutic purposesor other acceptable justification and shall not include actions involving Prohibited Substances
which are not prohibited in Out-of-Competition Testing unless the circumstances as a wholedemonstrate that such Prohibited Substances are not intended for genuine and legal
therapeutic purposes or are intended to enhance sport performance.
Adverse Analytical Finding: A report from a WADA-accredited laboratory or other WADAapproved laboratory that, consistent with the International Standard for Laboratories andrelated Technical Documents, identifies in a Sample the presence of a Prohibited Substanceor its Metabolites or Markers (including elevated quantities of endogenous substances) or
evidence of the Use of a Prohibited Method.
Anti-Doping Organization: A Signatory that is responsible for adopting rules for initiating,
implementing or enforcing any part of the Doping Control process. This includes, for example,
the International Olympic Committee, the International Paralympic Committee, other Major
Event Organizations that conduct Testing at their Events, WADA, International Federations,and National Anti-Doping Organizations.
Athlete: Any Person who competes in sport at the international level (as defined by each
International Federation) or the national level (as defined by each National Anti-Doping
Organization). An Anti-Doping Organization has discretion to apply anti-doping rules to an
Athlete who is neither an International-Level Athlete nor a National-Level Athlete, and thus tobring them within the definition of “Athlete.” In relation to Athletes who are neither
International-Level nor National-Level Athletes, an Anti-Doping Organization may elect to:
conduct limited Testing or no Testing at all; analyze Samples for less than the full menu ofProhibited Substances; require limited or no whereabouts information; or not require advanceTUEs. However, if an Article 2.1, 2.3 or 2.5 anti-doping rule violation is committed by any
Athlete over whom an Anti-Doping Organization has authority who competes below theinternational or national level, then the Consequences set forth in the Code (except Article
14.3.2) must be applied. For purposes of Article 2.8 and Article 2.9 and for purposes of antidoping information and education, any Person who participates in sport under the authority of
any Signatory, government, or other sports organization accepting the Code is an Athlete.
[Comment: This definition makes it clear that all International- and National-Level Athletes are
subject to the anti-doping rules of the Code, with the precise definitions of international- andnational-level sport to be set forth in the anti-doping rules of the International Federations and

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National Anti-Doping Organizations, respectively. The definition also allows each National
Anti-Doping Organization, if it chooses to do so, to expand its anti-doping program beyond
International- or National-Level Athletes to competitors at lower levels of Competition or toindividuals who engage in fitness activities but do not compete at all. Thus, a National AntiDoping Organization could, for example, elect to test recreational-level competitors but notrequire advance TUEs. But an anti-doping rule violation involving an Adverse Analytical
Finding or Tampering, results in all of the Consequences provided for in the Code (with the
exception of Article 14.3.2). The decision on whether Consequences apply to recreationallevel Athletes who engage in fitness activities but never compete is left to the National AntiDoping Organization. In the same manner, a Major Event Organization holding an Event only
for masters-level competitors could elect to test the competitors but not analyze Samples forthe full menu of Prohibited Substances. Competitors at all levels of Competition should receive
the benefit of anti-doping information and education.]
Code: The World Anti-Doping Code.
Competition: A single race, match, game or singular sport contest. For example, a basketballgame or the finals of the Olympic 100-meter race in athletics. For stage races and other sport
contests where prizes are awarded on a daily or other interim basis the distinction between a
Competition and an Event will be as provided in the rules of the applicable International
Federation.
Event: A series of individual Competitions conducted together under one ruling body (e.g.,the Olympic Games, FINA World Championships, or Pan American Games).
In-Competition: Unless provided otherwise in the rules of an International Federation or theruling body of the Event in question, “In-Competition” means the period commencing twelve
hours before a Competition in which the Athlete is scheduled to participate through the end ofsuch Competition and the Sample collection process related to such Competition.
[Comment: An International Federation or ruling body for an Event may establish an "InCompetition" period that is different than the Event Period.]International-Level Athlete: Athletes who compete in sport at the international level, as
defined by each International Federation, consistent with the International Standard for
Testing and Investigations.
[Comment: Consistent with the International Standard for Testing and Investigations, theInternational Federation is free to determine the criteria it will use to classify Athletes as
International-Level Athletes, e.g., by ranking, by participation in particular International
Events, by type of license, etc. However, it must publish those criteria in clear and concise
form, so that Athletes are able to ascertain quickly and easily when they will become classified
as International-Level Athletes. For example, if the criteria include participation in certain
International Events, then the International Federation must publish a list of those International
Events.]Major Event Organizations: The continental associations of National Olympic Committees
and other international multi-sport organizations that function as the ruling body for any
continental, regional or other International Event.
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National Anti-Doping Organization: The entity(ies) designated by each country as
possessing the primary authority and responsibility to adopt and implement anti-doping rules,
direct the collection of Samples, the management of test results, and the conduct of hearingsat the national level. If this designation has not been made by the competent publicauthority(ies), the entity shall be the country’s National Olympic Committee or its designee.
National-Level Athlete: Athletes who compete in sport at the national level, as defined byeach National Anti-Doping Organization, consistent with the International Standard for Testing
and Investigations.
Possession: The actual, physical Possession, or the constructive Possession (which shallbe found only if the Person has exclusive control or intends to exercise control over theProhibited Substance or Prohibited Method or the premises in which a Prohibited Substanceor Prohibited Method exists); provided, however, that if the Person does not have exclusive
control over the Prohibited Substance or Prohibited Method or the premises in which a
Prohibited Substance or Prohibited Method exists, constructive Possession shall only befound if the Person knew about the presence of the Prohibited Substance or Prohibited
Method and intended to exercise control over it. Provided, however, there shall be no antidoping rule violation based solely on Possession if, prior to receiving notification of any kindthat the Person has committed an anti-doping rule violation, the Person has taken concrete
action demonstrating that the Person never intended to have Possession and has renounced
Possession by explicitly declaring it to an Anti-Doping Organization. Notwithstanding anything
to the contrary in this definition, the purchase (including by any electronic or other means) ofa Prohibited Substance or Prohibited Method constitutes Possession by the Person who
makes the purchase.
[Comment: Under this definition, steroids found in an Athlete's car would constitute a violation
unless the Athlete establishes that someone else used the car; in that event, the Anti-Doping
Organization must establish that, even though the Athlete did not have exclusive control overthe car, the Athlete knew about the steroids and intended to have control over the steroids.
Similarly, in the example of steroids found in a home medicine cabinet under the joint control
of an Athlete and spouse, the Anti-Doping Organization must establish that the Athlete knew
the steroids were in the cabinet and that the Athlete intended to exercise control over thesteroids. The act of purchasing a Prohibited Substance alone constitutes Possession, even
where, for example, the product does not arrive, is received by someone else, or is sent to athird party address.]
Prohibited List: The List identifying the Prohibited Substances and Prohibited Methods.
Prohibited Method: Any method so described on the Prohibited List.
Prohibited Substance: Any substance, or class of substances, so described on theProhibited List.
Signatories: Those entities signing the Code and agreeing to comply with the Code, as
provided in Article 23.
Testing: The parts of the Doping Control process involving test distribution planning, Sample
collection, Sample handling, and Sample transport to the laboratory.
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TUE: Therapeutic Use Exemption, as described in Article 4.4.
Use: The utilization, application, ingestion, injection or consumption by any means
whatsoever of any Prohibited Substance or Prohibited Method.
WADA: The World Anti-Doping Agency.
3.2

Further defined term from the International Standard for the Protection of Privacy andPersonal Information that is used in the International Standard for Therapeutic Use
Exemptions:
Personal Information: Information, including without limitation Sensitive Personal
Information, relating to an identified or identifiable Participant or relating to other Persons
whose information is Processed solely in the context of an Anti-Doping Organization’s AntiDoping Activities.
[3.2 Comment: It is understood that Personal Information includes, but is not limited to,
information relating to an Athlete’s name, date of birth, contact details and sporting affiliations,whereabouts, designated therapeutic use exemptions (if any), anti-doping test results, andresults management (including disciplinary hearings, appeals and sanctions). Personal
Information also includes personal details and contact information relating to other Persons,such as medical professionals and other Persons working with, treating or assisting an Athlete
in the context of Anti-Doping Activities. Such information remains Personal Information and isregulated by this Standard for the entire duration of its Processing, irrespective of whether the
relevant individual remains involved in organized sport.]

3.3

Further defined terms specific to the International Standard for Therapeutic Use Exemptions:
Therapeutic: Of or relating to the treatment of a medical condition by remedial agents or
methods; or providing or assisting in a cure.
Therapeutic Use Exemption Committee (or "TUEC"): The panel established by an AntiDoping Organization to consider applications for TUEs.
WADA TUEC: The panel established by WADA to review the TUE decisions of other AntiDoping Organizations.

3.4

Interpretation:
3.4.1

Unless otherwise specified, references to articles are references to articles of theInternational Standard for Therapeutic Use Exemptions.

3.4.2

The comments annotating various provisions of the International Standard for
Therapeutic Use Exemptions shall be used to interpret that International Standard.

3.4.3

The official text of the International Standard for Therapeutic Use Exemptions shall bemaintained by WADA and shall be published in English and French. In the event of
any conflict between the English and French versions, the English version shall prevail.

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PART TWO: STANDARDS AND PROCESS FOR GRANTING TUES
4.0

Obtaining a TUE
4.1

An Athlete may be granted a TUE if (and only if) he/she can show, by a balance of probability,that each of the following conditions is met:a.

The Prohibited Substance or Prohibited Method in question is needed to treat an acuteor chronic medical condition, such that the Athlete would experience a significant
impairment to health if the Prohibited Substance or Prohibited Method were to be
withheld.

b.

The Therapeutic Use of the Prohibited Substance or Prohibited Method is highly unlikely
to produce any additional enhancement of performance beyond what might be
anticipated by a return to the Athlete’s normal state of health following the treatment of
the acute or chronic medical condition.

c.

There is no reasonable Therapeutic alternative to the Use of the Prohibited Substanceor Prohibited Method.

d.

The necessity for the Use of the Prohibited Substance or Prohibited Method is not aconsequence, wholly or in part, of the prior Use (without a TUE) of a substance or
method which was prohibited at the time of such Use.
[Comment to 4.1: When a TUEC is deciding whether or not to recognize a TUE grantedby another Anti-Doping Organization (see Article 7, below), and when WADA isreviewing a decision to grant (or not to grant) a TUE (see Article 8, below), the issue willbe the same as it is for a TUEC that is considering an application for a TUE under article
6, below, i.e., has the Athlete demonstrated by a balance of probability that each of theconditions set out in article 4.1 is met?
The WADA documents titled “Medical Information to Support the Decisions of TUECs”,
posted on WADA’s website, should be used to assist in the application of these criteria
in relation to particular medical conditions.]

4.2

Unless one of the exceptions set out in Article 4.3 applies, an Athlete who needs to Use a
Prohibited Substance or Prohibited Method for Therapeutic reasons must obtain a TUE prior
to Using or Possessing the substance or method in question.

4.3

An Athlete may only be granted retroactive approval for his/her Therapeutic Use of a
Prohibited Substance or Prohibited Method (i.e., a retroactive TUE) if:a.

Emergency treatment or treatment of an acute medical condition was necessary; orb.

Due to other exceptional circumstances, there was insufficient time or opportunity for
the Athlete to submit, or for the TUEC to consider, an application for the TUE prior to
Sample collection; or

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c.

The applicable rules required the Athlete (see comment to Article 5.1) or permitted theAthlete (see Code Article 4.4.5) to apply for a retroactive TUE; or[Comment to 4.3(c): Such Athletes are strongly advised to have a medical file preparedand ready to demonstrate their satisfaction of the TUE conditions set out at Article 4.1,
in case an application for a retroactive TUE is necessary following Sample collection.]d.

It is agreed, by WADA and by the Anti-Doping Organization to whom the application fora retroactive TUE is or would be made, that fairness requires the grant of a retroactive
TUE.
[Comment to 4.3(d): If WADA and/or the Anti-Doping Organization do not agree to theapplication of Article 4.3(d), that may not be challenged either as a defense toproceedings for an anti-doping rule violation, or by way of appeal, or otherwise.]

5.0

TUE Responsibilities of Anti-Doping Organizations
5.1

Code Article 4.4 specifies (a) which Anti-Doping Organizations have authority to make TUE
decisions; (b) how those TUE decisions should be recognized and respected by other AntiDoping Organizations; and (c) when TUE decisions may be reviewed and/or appealed.
[Comment to 5.1: See Annex 1 for a flow-chart summarizing the key provisions of Code
Article 4.4.
Code Article 4.4.2 specifies the authority of a National Anti-Doping Organization to makeTUE decisions in respect of Athletes who are not International-Level Athletes. In case of
dispute as to which National Anti-Doping Organization should deal with the TUE applicationof an Athlete who is not an International-Level Athlete, WADA will decide. WADA’s decision
will be final and not subject to appeal.
Where national policy requirements and imperatives lead a National Anti-Doping
Organization to prioritize certain sports over others in its test distribution planning (ascontemplated by Article 4.4.1 of the International Standard for Testing and Investigations),
the National Anti-Doping Organization may decline to consider advance applications for
TUEs from Athletes in some or all of the non-priority sports, but in that case it must permit
any such Athlete from whom a Sample is subsequently collected to apply for a retroactive
TUE. The National Anti-Doping Organization should publicize any such policy on its website
for the benefit of affected Athletes.]

5.2

Each National Anti-Doping Organization, International Federation and Major Event
Organization must establish a TUEC to consider whether applications for grant or recognition
of TUEs meet the conditions set out in Article 4.1.
[Comment to 5.2: While a Major Event Organization may choose to recognize pre-existing
TUEs automatically, there must be a mechanism for Athletes participating in the Event toobtain a new TUE if the need arises. It is up to each Major Event Organization whether it sets
up its own TUEC for this purpose, or rather whether it outsources the task by agreement toa third party (such as Sport Accord). The aim in each case should be to ensure that Athletes

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competing in such Events have the ability to obtain TUEs quickly and efficiently before they
compete.]a.

TUECs should include at least three physicians with experience in the care andtreatment of Athletes and a sound knowledge of clinical, sports and exercise medicine.
In cases involving Athletes with impairments, at least one TUEC member should
possess general experience in the care and treatment of Athletes with impairments, orpossess specific experience in relation to the Athlete’s particular impairment(s).

b.

In order to ensure a level of independence of decisions, at least a majority of themembers of a TUEC should have no political responsibility in the Anti-Doping
Organization that appoints them. All members of the TUEC must sign a conflict ofinterest and confidentiality declaration. (A template declaration is available on WADA’s
website).

5.3

Each National Anti-Doping Organization, International Federation and Major Event
Organization must establish a clear process for applying to its TUEC for a TUE that complies
with the requirements of this International Standard. It must also publish details of thatprocess by (at a minimum) posting the information in a conspicuous place on its website andsending the information to WADA. WADA may re-publish the same information on its own
website.

5.4

Each National Anti-Doping Organization, International Federation and Major Event
Organization must promptly report (in English or French) all decisions of its TUEC granting
or denying TUEs, and all decisions to recognize or refusing to recognize other Anti-Doping
Organizations' TUE decisions, through ADAMS or any other system approved by WADA. In
respect of TUEs granted, the information reported shall include (in English or French):a.

not only the approved substance or method, but also the dosage(s), frequency and routeof Administration permitted, the duration of the TUE, and any conditions imposed inconnection with the TUE; andb.

the TUE application form and the relevant clinical information (translated into English or
French) establishing that the Article 4.1 conditions have been satisfied in respect of such
TUE (for access only by WADA, the Athlete’s National Anti-Doping Organization andInternational Federation, and the Major Event Organization organizing an Event in which
the Athlete wishes to compete).
[Comment to 5.4: The process of recognition of TUEs is greatly facilitated by use of
ADAMS.]

5.5

When a National Anti-Doping Organization grants a TUE to an Athlete, it must warn him/her
in writing (a) that that TUE is valid at national level only, and (b) that if the Athlete becomesan International-Level Athlete or competes in an International Event, that TUE will not bevalid for those purposes unless it is recognized by the relevant International Federation or
Major Event Organization in accordance with Article 7.1. Thereafter, the National Anti-Doping
Organization should help the Athlete to determine when he/she needs to submit the TUE toan International Federation or Major Event Organization for recognition, and should guideand support the Athlete through the recognition process.

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6.0

5.6

Each International Federation and Major Event Organization must publish a notice (at aminimum, by posting it in a conspicuous place on its website and sending it to WADA) thatsets out clearly (1) which Athletes coming under its jurisdiction are required to apply to it fora TUE, and when; (2) which TUE decisions of other Anti-Doping Organizations it willautomatically recognize in lieu of such application, in accordance with Article 7.1(a); and (3)which TUE decisions of other Anti-Doping Organizations will have to be submitted to it forrecognition, in accordance with Article 7.1(b). WADA may re-publish the notice on its own
website.

5.7

Any TUE that an Athlete has obtained from a National Anti-Doping Organization shall not bevalid if the Athlete becomes an International-Level Athlete or competes in an International
Event unless and until the relevant International Federation recognizes that TUE inaccordance with Article 7.0. Any TUE that an Athlete has obtained from an International
Federation shall not be valid if the Athlete competes in an International Event organized bya Major Event Organization, unless and until the relevant Major Event Organization
recognizes that TUE in accordance with Article 7.0. As a result, if the International Federationor Major Event Organization (as applicable) declines to recognize that TUE, then (subject to
the Athlete’s rights of review and appeal) that TUE may not be relied upon to excuse thepresence, Use, Possession or Administration of the Prohibited Substance or Prohibited
Method mentioned in the TUE vis-à-vis that International Federation or Major Event
Organization.

TUE Application Process
6.1

An Athlete who needs a TUE should apply as soon as possible. For substances prohibited
In-Competition only, the Athlete should apply for a TUE at least 30 days before his/her next
Competition, unless it is an emergency or exceptional situation. The Athlete should apply tohis/her National Anti-Doping Organization, International Federation and/or a Major Event
Organization (as applicable), using the TUE application form provided. Anti-Doping
Organizations shall make the application form they want Athletes to use available fordownload from their websites. That form must be based on the “TUE Application Form”
template available on WADA’s website. The template may be modified by Anti-Doping
Organizations to include additional requests for information, but no sections or items may beremoved.

6.2

The Athlete should submit the TUE application form to the relevant Anti-Doping Organization
via ADAMS or as otherwise specified by the Anti-Doping Organization. The form must be
accompanied by:a. a statement by an appropriately qualified physician, attesting to the need for the Athlete
to Use the Prohibited Substance or Prohibited Method in question for Therapeutic
reasons; andISTUE – January 2019

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b. a comprehensive medical history, including documentation from the original diagnosing
physician(s) (where possible) and the results of all examinations, laboratory
investigations and imaging studies relevant to the application.
[Comment to 6.2(b): The information submitted in relation to the diagnosis, treatment
and duration of validity should be guided by the WADA documents titled “Medical
Information to Support the Decisions of TUECs”.]
6.3

The Athlete should keep a complete copy of the TUE application form and of all materials
and information submitted in support of that application.

6.4

A TUE application will only be considered by the TUEC following the receipt of a properly
completed application form, accompanied by all relevant documents. Incomplete applications
will be returned to the Athlete for completion and re-submission.

6.5

The TUEC may request from the Athlete or his/her physician any additional information,
examinations or imaging studies, or other information that it deems necessary in order toconsider the Athlete’s application; and/or it may seek the assistance of such other medicalor scientific experts as it deems appropriate.

6.6

Any costs incurred by the Athlete in making the TUE application and in supplementing it asrequired by the TUEC are the responsibility of the Athlete.

6.7

The TUEC shall decide whether or not to grant the application as soon as possible, andusually (i.e., unless exceptional circumstances apply) within no more than 21 days of receipt
of a complete application. Where a TUE application is made a reasonable time prior to an
Event, the TUEC must use its best endeavors to issue its decision before the start of the
Event.

6.8

The TUEC’s decision must be communicated in writing to the Athlete and must be madeavailable to WADA and to other Anti-Doping Organizations via ADAMS or any other systemapproved by WADA, in accordance with Article 5.3.

6.9

a.

A decision to grant a TUE must specify the dosage(s), frequency, route and duration of
Administration of the Prohibited Substance or Prohibited Method in question that the
TUEC is permitting, reflecting the clinical circumstances, as well as any conditions
imposed in connection with the TUE.

b.

A decision to deny a TUE application must include an explanation of the reason(s) for
the denial.

Each TUE will have a specified duration, as decided by the TUEC, at the end of which the
TUE will expire automatically. If the Athlete needs to continue to Use the Prohibited
Substance or Prohibited Method after the expiry date, he/she must submit an application for
a new TUE well in advance of that expiry date, so that there is sufficient time for a decision
to be made on the application before the expiry date.
[Comment to 6.9: The duration of validity should be guided by the WADA documents titled“Medical Information to Support the Decisions of TUECs”.]

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6.10 A TUE will be withdrawn prior to expiry if the Athlete does not promptly comply with any
requirements or conditions imposed by the Anti-Doping Organization granting the TUE.
Alternatively a TUE may be reversed upon review by WADA or on appeal.
6.11 Where an Adverse Analytical Finding is issued shortly after a TUE for the Prohibited
Substance in question has expired or has been withdrawn or reversed, the Anti-Doping
Organization conducting the initial review of the Adverse Analytical Finding (Code Article 7.2)
shall consider whether the finding is consistent with Use of the Prohibited Substance prior to
the expiry, withdrawal or reversal of the TUE. If so, such Use (and any resulting presence of
the Prohibited Substance in the Athlete’s Sample) is not an anti-doping rule violation.
6.12 In the event that, after his/her TUE is granted, the Athlete requires a materially different
dosage, frequency, route or duration of Administration of the Prohibited Substance or
Prohibited Method to that specified in the TUE, he/she must apply for a new TUE. If thepresence, Use, Possession or Administration of the Prohibited Substance or Prohibited
Method is not consistent with the terms of the TUE granted, the fact that the Athlete has the
TUE will not prevent the finding of an anti-doping rule violation.
7.0

TUE Recognition Process
7.1

Code Article 4.4 requires Anti-Doping Organizations to recognize TUEs granted by otherAnti-Doping Organizations that satisfy the Article 4.1 conditions. Therefore, if an Athlete who
becomes subject to the TUE requirements of an International Federation or Major Event
Organization already has a TUE, he/she should not submit an application for a new TUE to
the International Federation or Major Event Organization. Instead:a.

The International Federation or Major Event Organization may publish notice that it willautomatically recognize TUE decisions made pursuant to Code Article 4.4 (or certain
categories of such decisions, e.g., those made by specified Anti-Doping Organizations,or those relating to particular Prohibited Substances), provided that such TUE decisions
have been reported in accordance with Article 5.3 and therefore are available for review
by WADA. If the Athlete’s TUE falls into a category of TUEs that are automaticallyrecognized in this way at the time the TUE is granted, he/she does not need to take any
further action.
[Comment to 7.1(a): To ease the burden on Athletes, automatic recognition of TUE
decisions once they have been reported in accordance with Article 5.3 is strongly
encouraged. If an International Federation or Major Event Organizer is not willing to
grant automatic recognition of all such decisions, it should grant automatic recognitionof as many such decisions as possible, e.g., by publishing a list of Anti-Doping
Organizations whose TUE decisions it will recognize automatically, and/or a list of those
Prohibited Substances for which it will automatically recognize TUEs. Publication should
be in the same manner as is set out in Article 5.3, i.e., the notice should be posted on
the International Federation’s website and sent to WADA and to National Anti-Doping
Organizations.]b.

In the absence of such automatic recognition, the Athlete shall submit a request forrecognition of the TUE to the International Federation or Major Event Organization in

ISTUE – January 2019

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question, either via ADAMS or as otherwise specified by that International Federation or
Major Event Organization. The request should be accompanied by a copy of the TUE
and the original TUE application form and supporting materials referenced at Articles
6.1 and 6.2 (unless the Anti-Doping Organization that granted the TUE has alreadymade the TUE and supporting materials available via ADAMS or other system approved
by WADA, in accordance with Article 5.3).

8.0

7.2

Incomplete requests for recognition of a TUE will be returned to the Athlete for completion
and re-submission. In addition, the TUEC may request from the Athlete or his/her physician
any additional information, examinations or imaging studies, or other information that it
deems necessary in order to consider the Athlete’s request for recognition of the TUE; and/or
it may seek the assistance of such other medical or scientific experts as it deems appropriate.

7.3

Any costs incurred by the Athlete in making the request for recognition of the TUE and insupplementing it as required by the TUEC are the responsibility of the Athlete.

7.4

The TUEC shall decide whether or not to recognize the TUE as soon as possible, and usually(i.e., unless exceptional circumstances apply) within no more than 21 days of receipt of acomplete request for recognition. Where the request is made a reasonable time prior to an
Event, the TUEC must use its best endeavors to issue its decision before the start of the
Event.

7.5

The TUEC’s decision will be notified in writing to the Athlete and will be made available to
WADA and to other Anti-Doping Organizations via ADAMS or any other system approved by
WADA. A decision not to recognize a TUE must include an explanation of the reason(s) for
the non-recognition.

Review of TUE Decisions by WADA
8.1

Code Article 4.4.6 provides that WADA, in certain cases, must review TUE decisions ofInternational Federations, and that it may review any other TUE decisions, in each case todetermine compliance with the Article 4.1 conditions. WADA shall establish a WADA TUEC
that meets the requirements of Article 5.2 to carry out such reviews.

8.2

Each request for review must be submitted to WADA in writing, and must be accompanied
by payment of the application fee established by WADA, as well as copies of all of theinformation specified in Article 6.2 (or, in the case of review of a TUE denial, all of theinformation that the Athlete submitted in connection with the original TUE application). The
request must be copied to the party whose decision would be the subject of the review, andto the Athlete (if he/she is not requesting the review).

8.3

Where the request is for review of a TUE decision that WADA is not obliged to review,
WADA shall advise the Athlete as soon as practicable following receipt of the request
whether or not it will refer the TUE decision to the WADA TUEC for review. If WADA decides
not to refer the TUE decision, it will return the application fee to the Athlete. Any decision by
WADA not to refer the TUE decision to the WADA TUEC is final and may not be appealed.
However, the TUE decision may still be appealable, as set out in Code Article 4.4.7.

8.4

Where the request is for review of a TUE decision of an International Federation that WADA
is obliged to review, WADA may nevertheless refer the decision back to the International

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Federation (a) for clarification (for example, if the reasons are not clearly set out in thedecision); and/or (b) for re-consideration by the International Federation (for example, if the
TUE was only denied because medical tests or other information required to demonstratesatisfaction of the Article 4.1 conditions were missing).
8.5

Where a request for review is referred to the WADA TUEC, the WADA TUEC may seek
additional information from the Anti-Doping Organization and/or the Athlete, including further
studies as described in Article 6.5, and/or it may obtain the assistance of other medical orscientific experts as it deems appropriate.

8.6

The WADA TUEC shall reverse any grant of a TUE that does not comply with the Article 4.1
conditions. Where the TUE reversed was a prospective TUE (rather than a retroactive TUE),
such reversal shall take effect upon the date specified by WADA (which shall not be earlier
than the date of WADA’s notification to the Athlete). The reversal shall not apply retroactively
and the Athlete’s results prior to such notification shall not be Disqualified. Where the TUE
reversed was a retroactive TUE, however, the reversal shall also be retroactive.

8.7

The WADA TUEC shall reverse any denial of a TUE where the TUE application met the
Article 4.1 conditions, i.e., it shall grant the TUE.

8.8

Where the WADA TUEC reviews a decision of an International Federation that has beenreferred to it pursuant to Code Article 4.4.3 (i.e., a mandatory review), it may require
whichever Anti-Doping Organization “loses” the review (i.e., the Anti-Doping Organization
whose view it does not uphold) (a) to reimburse the application fee to the party that referred
the decision to WADA (if applicable); and/or (b) to pay the costs incurred by WADA in
respect of that review, to the extent they are not covered by the application fee.

8.9

Where the WADA TUEC reverses a TUE decision that WADA has decided in its discretion
to review, WADA may require the Anti-Doping Organization that made the decision to pay
the costs incurred by WADA in respect of that review.

8.10 WADA shall communicate the reasoned decision of the WADA TUEC promptly to the
Athlete and to his/her National Anti-Doping Organization and International Federation (and,if applicable, the Major Event Organization).
9.0

Confidentiality of Information
9.1

The collection, storage, processing, disclosure and retention of Personal Information during
the TUE process by Anti-Doping Organizations and WADA shall comply with theInternational Standard for the Protection of Privacy and Personal Information.

9.2

An Athlete applying for the grant of a TUE or for recognition of a TUE shall provide writtenconsent:
a. for the transmission of all information pertaining to the application to members of all
TUECs with authority under this International Standard to review the file and, as
required, other independent medical or scientific experts, and to all necessary staff(including WADA staff) involved in the management, review or appeal of TUE
applications;

ISTUE – January 2019

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b. for the Athlete’s physician(s) to release to the TUEC upon request any health informationthat the TUEC deems necessary in order to consider and determine the Athlete’s
application; andc. for the decision on the application to be made available to all Anti-Doping Organizations
with Testing authority and/or results management authority over the Athlete.
[Comment to 9.2: Prior to collecting Personal Information or obtaining consent from an
Athlete, the Anti-Doping Organization shall communicate to the Athlete the information
set out in Article 7.1 of the International Standard for the Protection of Privacy andPersonal Information.]
9.3

The TUE application shall be dealt with in accordance with the principles of strict medical
confidentiality. The members of the TUEC, independent experts and the relevant staff of
the Anti-Doping Organization shall conduct all of their activities relating to the process instrict confidence and shall sign appropriate confidentiality agreements. In particular theyshall keep the following information confidential:
a. All medical information and data provided by the Athlete and physician(s) involved in the
Athlete’s care.
b. All details of the application, including the name of the physician(s) involved in
the process.

9.4

Should the Athlete wish to revoke the right of the TUEC to obtain any health information on
his/her behalf, the Athlete shall notify his/her medical practitioner in writing of such
revocation; provided that, as a result of that revocation, the Athlete’s application for a TUE
or for recognition of an existing TUE will be deemed withdrawn without approval/recognition
having been granted.

9.5

Anti-Doping Organizations shall only use information submitted by an Athlete in connection
with a TUE application to evaluate the application and in the context of potential anti-doping
rule violation investigations and proceedings.

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ANNEX 1: CODE ARTICLE 4.4 FLOW-CHART

1.

TUE procedure if Athlete is not an International-Level Athlete when need for TUE arises

Athlete may
appealNATIONAL-LEVELAPPEAL BODY

2.

NADO
TUEC

Apply for TUE

Athlete is not an International-Level Athlete

TUE granted

TUE denied

Athlete enters Event for which Major Event Organization (or "MEO") has its own TUE requirements

Does Athlete have a TUE already?

Is the TUE in a category of TUE decisions
that are automatically recognized by MEO?
Yes

Yes

No

TUE
recognizedNo further action
required

Submit TUE for recognition

TUE not
recognized

MEO TUEC

TUE
grantedTUE not
grantedAthlete may appeal
non-recognition

MEO APPEAL BODYISTUE – January 2019No

Athlete may
appeal non-grant

Page 20 of 21

3.

TUE Procedure if Athlete is an International-Level Athlete (and so subject to the International Federation's TUE
requirements) when need for TUE arises

Does Athlete have a TUE already granted atnational level?

Is TUE in a category of TUE decisions thatare automatically recognized by IF?

Yes

No

Apply for TUE

Yes

No

TUE
recognizedNo further action
required

Submit TUE for recognition

TUE not
recognized

IF TUEC

TUE granted

Athlete and/or NADO may
refer the non-recognition
to WADANADO may refer
the grant to
WADA

TUE not
grantedWADA may agree toAthlete request toreview decision not
to grant TUE

WADA TUEC

IF decision upheld

Athlete and/or NADO
may appeal

IF decision reversed
Athlete may
appealIF may appeal
CAS

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