Clean Sport for Humans - Therapeutic Use Exemptions (TUEs)

WHAT IS A THERAPEUTIC USE EXEMPTION  (TUE) ?
Athletes, like all people, may have illnesses or conditions that require them to take particular medications or undergo procedures. If the medication or method an athlete is required to take/use to treat an illness or condition is included in the World Anti-Doping Agency’s (WADA) Prohibited List, a Therapeutic Use Exemption (TUE) makes it possible for the athlete to take the treatment without committing an anti-doping rule violation.
Applications for TUEs are reviewed by a panel of experts, the FEI TUE Committee (TUEC), and will be approved if the conditions set by WADA’s International Standard for Therapeutic Use Exemptions (ISTUE) are satisfied.

WHAT ARE THE CRITERIA FOR GRANTING A TUE ?
For a TUE to be granted, all of the four following criteria must be met (for more details, please refer to the WADA International Standard for Therapeutic Use Exemptions (ISTUE) Article 4.2:

  • The prohibited substance or method in question is needed to treat a diagnosed medical condition supported by relevant clinical evidence.
  • The therapeutic use of the prohibited substance or method will not produce any additional enhancement of performance beyond a return to the athlete’s normal state of health following the treatment.
  • The prohibited substance or method is an indicated treatment for the medical condition, and there is no reasonable permitted therapeutic alternative.
  • The necessity for the use of the prohibited substance or method is not a consequence of the use (without a TUE) of a substance or method which was prohibited at the time of use.


SHOULD YOU APPLY FOR A TUE, AND IF SO, WHERE AND WHEN ?  
Follow these steps to find out if you need a TUE and where to apply for it:
STEP 1: Check if the medication or method you intend to take or use appears on the Prohibited List.
Useful links:

You have the responsibility to inform your doctors that you are an athlete subject to doping control, and your doctors should check the Prohibited List whenever they prescribe a medication or method to you. If the substance/method is prohibited, check with your doctors if there are any alternative treatments that are not prohibited. If not, you have to apply for a TUE.

STEP 2: check your competition level to determine when and to which organisation you must apply for a TUE.
==> If you are a FEI “International-Level Athlete”
you must apply to the FEI in advance, as soon as the need arises, unless there are emergency or exceptional circumstances. You are an “International-Level Athlete” if you meet either of the following criteria:

  1. You are ranked as listed below in the Ranking(s) applicable on 1 January for the year considered in any of the FEI disciplines (all Rankings can be accessed) here:
    - Jumping: top 500 of the FEI Jumping World Rankings (= “Longines Rankings”)
    - Dressage: top 300 of the FEI Dressage World Rankings
    - Eventing: top 300 of the FEI Eventing World Rankings
    - Para Dressage: top 100 of the FEI Para Dressage World Rankings (= "World Individual Rankings")
    - Endurance: top 100 of the FEI Endurance World Rankings
    - Driving: top 100 of the FEI Driving World Rankings
    - Vaulting: top 100 of the FEI Vaulting World Rankings
    - Reining: top 100 of the FEI Reining World Rankings
  2. You are included in the FEI’s Registered Testing Pool (RTP) and/or Testing Pool (TP).
    To apply for a TUE, please refer to the section “How to apply to the FEI for a TUE?” below.

For substances prohibited in-competition only, you should apply for a TUE at least 30 days before your next competition.
Note: If you already have a TUE granted by your National Anti-Doping Organisation (NADO) and reported in accordance with Article 5.5 of WADA’s International Standard for Therapeutic Use Exemptions    (ISTUE), the FEI will automatically recognise it for purposes of international-level competition (you do not need to apply again to the FEI).

==> If you are NOT an International-Level Athlete, you must apply to your NADO for a TUE. If you have been tested by the FEI, are using a Prohibited Substance or Prohibited Method for therapeutic reasons, and were not required by your NADO’s rules to apply for a TUE (i.e., you are not a National-Level Athlete as defined by your NADO), the FEI will allow you to apply for a retroactive TUE.

CAN I GET A RETROACTIVE TUE ?
You may only apply retroactively for a TUE
(but must still meet the basic conditions listed in section “WHAT ARE THE CRITERIA FOR GRANTING A TUE?” above) to the FEI if:

  • Emergency or urgent treatment of a medical condition was necessary.
  • There was insufficient time, opportunity or other exceptional circumstances that prevented you from submitting (or the FEI TUE Committee to consider) an application for the TUE prior to sample collection.
  • Due to national-level prioritisation of certain sports, your National Anti-Doping Organisation did not permit or require that you apply for a prospective TUE.
  • If you were tested by the FEI, are not an International-Level Athlete or National-Level Athlete, and are using a prohibited substance or method for therapeutic reasons, the FEI must allow you to apply for a retroactive TUE; or
  • You used out-of-competition, for therapeutic reasons, a substance that is only prohibited in-competition.

Finally, in exceptional circumstances the FEI may grant a retroactive TUE if it considers that it would be manifestly unfair not to grant it. For International-Level Athletes and National-Level Athletes, this decision will require the prior approval of WADA.   For more details, please refer to WADA’s International Standard for Therapeutic Use Exemptions (ISTUE), articles 4.1 and 4.3.

Important note: using a prohibited substance or method before being granted a TUE could result in an Adverse Analytical Finding and a potential anti-doping rule violation. You are strongly advised to have a medical file prepared and ready to submit for evaluation in case an application for a retroactive TUE is necessary following sample collection.

HOW DO I APPLY TO THE FEI FOR A TUE?
The FEI encourages TUE applications using the form available in ADAMS, and submitting the required medical file through ADAMS. If you do not have an ADAMS account yet, please contact the FEI TUE team at tue@ita.sport  to have your account set up.
Otherwise, please download the FEI’s TUE Application Form, and once duly completed and signed, send it together with the required medical file to the FEI TUE team at tue@ita.sport.
Your TUE application must be submitted in legible English (or French) using capital letters or typing.

The medical file includes:

  • 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.
  • If the medical file is not in English or French, a summary explaining, in English or French, the key elements of the diagnosis, clinical examinations, medical tests and treatment plan must be provided.

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 you and your doctor in providing the correct medical documentation, we suggest consulting the WADA’s Checklists for TUE applications for guidance and support, and Medical Information to Support the Decisions of TUECs 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.

WHEN WILL I RECEIVE A DECISION ON MY TUE APPLICATION ? 
The decision of the FEI’s TUE Committee (TUEC) will be communicated in writing to you (unless exceptional circumstances apply) within 21 days from the date of receipt by the FEI of the complete TUE application, including the required medical information.

WHAT ABOUT THE RENEWAL OF MY TUE ?
Each TUE has a specific duration, at the end of which it expires automatically. If 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 the expiry date, so that there is sufficient time for a decision to be made before your current TUE expires.

Important Note: 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, in the event that, after your TUE is granted, you require a materially different dosage, frequency, route or duration of administration, you must apply for a new TUE.

WHAT IF MY TUE APPLICATION IS DENIED BY THE FEI ?
A decision to deny a TUE application includes an explanation of the reason(s) for the denial. If it is not clear to you, please contact the FEI to understand exactly why the TUE was denied. Sometimes, there may be a critical piece of information, diagnostic test, laboratory results missing, etc. Failing this, you and/or your NADO may refer the matter to WADA for review no later than 21 days after the decision was rendered by the FEI TUEC by sending the same information that you submitted to the FEI TUEC and on which they based their decision to deny the TUE via registered mail at: WADA Medical Director
World Anti-Doping Agency
800 Square Victoria
Montreal, H4Z 1B7, QC
Canada

However, WADA is not obliged to proceed with such review. In that case, you and/or your NADO may appeal to the Court of Arbitration for Sport (CAS).

WHAT ABOUT CONFIDENTIALITY ?
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, and in the FEI’s TUE Application Form. All members of the FEI TUEC and any other authorised 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, please note that should you wish to revoke the right of the FEI’s TUEC to obtain the information related to your TUE request in accordance with the Athlete’s Declaration, your TUE application will be deemed withdrawn without approval being granted.   Your TUE request-related information will be retained by the FEI and any other authorised recipients for no longer than necessary for the purposes stated in the Athlete’s Declaration, in accordance with WADA’s International Standard for the Protection of Privacy and Personal Information (ISPPPI).

CONTACT INFORMATION

  • For questions in relation to the FEI’s personal information practices, please contact Catherine.Bollon@fei.org.
  • If you have a doubt as regards to which organisation you should apply for a TUE, or any other question with regard to TUEs, please contact: tue@ita.sport.