What is a Therapeutic Use Exemption (TUE)?
Athletes may have illnesses or conditions that require them to take medications or undergo medical procedures. If the medication or method an athlete is required to use to treat an illness or condition is prohibited as per the World Anti-Doping Agency’s (WADA) Prohibited List a TUE may give that athlete the authorization to use that substance or method while competing without invoking an anti-doping rule violation (ADRV) and applicable sanction.
Applications for TUEs are evaluated by a panel of physicians, the IMMAF TUE Committee (TUEC).
Confidentiality is maintained at all times.
Check if you are eligible to apply for a TUE at IMMAF. Download the TUE Form
What are the criteria for granting a TUE?
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 athlete has a clear diagnosed medical condition which requires treatment using a prohibited substance or method;
- The therapeutic use of the substance will not, on the balance of probabilities produce significant enhancement of performance beyond the athlete’s normal state of health;
- The prohibited substance or method is an indicated treatment for the medical condition, and there is no reasonable permitted therapeutic alternative;
- The necessity to use that substance or method is not a consequence of the prior use (without a TUE), of a substance or method which was prohibited at the time of use.
Who should apply for a TUE? Where and when to apply?
Athletes who are subject to anti-doping rules would need a TUE to take a prohibited substance or use a prohibited method. You should verify your TUE with IMMAF or your national MMA body or NADO to know to whom you need to apply, and if you can apply retroactively.
First, check if the required medication or method you intend to take, or use is prohibited. You may do this in two ways:
– as per the WADA Prohibited List. [Prohibited List]
You may also use a ‘check your medication’ website online tool or ask your NADO if it has one. Thoroughly research the medication you intend to take to ensure it is not prohibited. Keep records of your research.
You have a responsibility to inform your physician(s) that you are an Athlete bound to anti-doping rules. You and your physician(s) should check the Prohibited List for the substance/method you are prescribed. If the substance/method is prohibited, discuss non-prohibited alternatives, if there is none, apply for a TUE.
Remember Athletes have the ultimate responsibility in terms of the strict liability rule. Contact your NADO or IMMAF if you are having difficulties.
Then, check on the IMMAF website [IMMAF Rules & Testing Policy] or contact your national federation to determine your competition level and TUE application requirements.
If it is determined that you are an International-Level Athlete
- Athletes included in the IMMAF Registered Testing Pool and any other Testing Pool established by IMMAF
- Athletes who compete in an IMMAF sanctioned World or European Championships (Senior or Junior) International Event,
- Athletes who are sanctioned by IMMAF for an Anti-Doping Rule Violation and remain under IMMAF jurisdiction to seek reinstatement at the conclusion of their suspension.
As an International- Level Athlete you must apply to IMMAF in advance, as soon as the need arises, unless there are emergency or exceptional circumstances.
For substances prohibited in-competition only, you should apply for a TUE at least 30 days before your next competition, unless one of the exceptions on retroactive TUEs (see below) apply.
Please refer to the section “How to apply to IMMAF for a TUE?” below.
If you already have a TUE granted by your National Anti-Doping Organization (NADO):
IMMAF shall automatically recognise a TUE granted in accordance with the International Standard for TUEs.
[Note: The TUE Certificate must be submitted to IMMAF in advance of an international event you intend to participate in to be recognized at the international level].
In such case, please notify IMMAF via [email protected] that you have a TUE granted by your NADO.
ª If you are NOT an International-Level Athlete and you have been tested by IMMAF, IMMAF recognizes a valid TUE granted by your NADO (i.e., it satisfies the ISTUE criteria for granting a TUE).
If you are NOT a National-Level Athlete as defined by your NADO and you have been tested by IMMAF, you must apply for a retroactive TUE to IMMAF.
Retroactive TUE Application Process:
An Athlete may apply retroactively for a TUE (but must still meet the conditions in ISTUE Article 4.2) if one of any of the following exceptions applies:
a) Emergency or urgent treatment of a medical condition was necessary;
b) There was insufficient time, opportunity or other exceptional circumstances that prevented the Athlete from submitting (or the TUEC to consider) an application for the TUE prior to Sample collection;
c) Due to national level prioritization of certain sports, the Athlete’s National Anti-Doping Organization did not permit or require the Athlete to apply for a prospective TUE (see comment to Article 5.1);
d) If an Anti-Doping Organization chooses to collect a Sample from an Athlete who is not an International-Level Athlete or National-Level Athlete, and that Athlete is Using a Prohibited Substance or Prohibited Method for Therapeutic reasons, the Anti-Doping Organization must permit the Athlete to apply for a retroactive TUE; or
e) The Athlete Used Out-of-Competition, for Therapeutic reasons, a Prohibited Substance that is only prohibited In-Competition.
[Comment: Athletes are strongly advised to have a medical file prepared and ready to demonstrate their satisfaction of the TUE conditions set out at Article 4.2, in case an application for a retroactive TUE is necessary following Sample collection.]
[Comment to Article 4.1(e): This seeks to address situations where, for Therapeutic reasons, an Athlete Uses a substance Out-of-Competition that is only prohibited In-Competition, but there is a risk that the substance will remain in their system In-Competition. In such situations, the Anti-Doping Organization must permit the Athlete to apply for a retroactive TUE (where the Athlete has not applied in advance). This also seeks to prevent Anti-Doping Organizations from having to assess advance TUE applications that may not be necessary.]
How to apply to IMMAF for a TUE
[Note: Once IMMAF has been granted signatory status you may apply through ADAMS or via the electronic form available on IMMAF’s website, Anti-Doping section. Until then, please follow option 2 below.]
[Option 1 – only through ADAMS]
You must exclusively submit your TUE application, including the required medical file, via ADAMS. If you do not have an ADAMS account yet, please contact IMMAF [[email protected] ] to have your account set up.
[Option 2 –paper format / electronic TUE form]
Otherwise, please download the IMMAF TUE Application Form [IMMAF TUE Application Form] and once duly completed and signed, send it together with the required medical file to [email protected].
Your 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.
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.
How to submit request for recognition of my NADO’s TUE to IMMAF?
Your request for recognition should be submitted to IMMAF [[email protected]] in writing quoting your ADAMS TUE reference number and attaching a copy of your TUE Certificate of Approval valid for the time you are competing in an IMMAF event.
Keep a complete copy of the proof that your request for recognition has been sent to IMMAF.
When will I receive a decision on my TUE application (or request for recognition)?
IMMAF’s TUEC must render a decision as soon as possible, and usually within 21 days from the date of receipt of the complete TUE application [or request for recognition].
What if I need to renew my TUE?
Each TUE has a specific duration, at the end of which it expires automatically. Should 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 of the expiry date, so that there is sufficient time for a decision to be made prior to the expiry of the current TUE.
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, if you require a materially different dosage, frequency, route or duration of administration, you should contact IMMAF, as you may be required to apply for a new TUE. Some substances and dosages, e.g., insulin, are often modified during treatment and these possible fluctuations should be mentioned by the treating physician in the TUE application and would usually be accepted by the ADO TUEC.
What if my IMMAF’s TUE application is denied?
A decision to deny a TUE application will include a written explanation of the reason(s) for the denial. If it is not clear to you, please contact IMMAF to understand exactly why the TUE was denied. Sometimes, there may be a critical piece of information, diagnostic test, laboratory results missing, etc. In which case, you should re-apply to us.
You and/or your NADO may refer the matter to WADA for review no later than 21 days after notification of the IMMAF TUEC decision. You should send the same information that you submitted to us, and on which the decision to deny the TUE was based on, via a secure on-line method or by registered mail at:
WADA Medical Department
World Anti-Doping Agency
Stock Exchange Tower
800 Place Victoria (Suite 1700)
P.O. Box 120
Montreal (Quebec) H4Z 1B7
The email address to enquire and/or send the request for review is: [email protected]
It should be noted that WADA is not obliged to proceed with a request for a review. In that case, you and/or your NADO may appeal to the Court of Arbitration for Sport (CAS).
What if my NADO’s TUE is not recognised by IMMAF?
You and/or your NADO have 21 days from the date of decision to refer the matter to WADA for review. The email address to enquire and/or send the request for review is: [email protected]. Alternatively, you may send to:
WADA Medical Department
World Anti-Doping Agency
Stock Exchange Tower
800 Place Victoria (Suite 1700)
P.O. Box 120
Montreal (Quebec) H4Z 1B7
The same information that was provided to your NADO should be submitted to WADA. Please use a secure on-line method unless sending by registered mail.
Pending WADA’s decision, your NADO TUE remains valid for national-level competition and out-of-competition testing only.
If the matter is not referred to WADA for review, your NADO must determine whether the original TUE that was granted should remain valid for national-level Competition and Out-of-Competition Testing.
Will my medical information be treated in a confidential manner?
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 IMMAF’s TUE Application Form. All members of the TUEC and any other authorized recipients of your TUE request and related information (as described in the Athlete’s Declaration) are subject to a professional contractual confidentiality obligation.
Please review the terms of the Athlete’s Declaration carefully. In particular, note that should you wish to revoke the right of the IMMAF’s TUEC to obtain the information related to your TUE in accordance with the Athlete’s Declaration, your TUE application will be deemed withdrawn without approval [or recognition] being granted.
Your TUE request-related information will be retained by IMMAF and any other authorized recipients for no longer than necessary for the purposes stated in the Athlete’s Declaration, in accordance with the International Standard for the Protection of Privacy and Personal Information.
For any further information and questions in relation to IMMAF’s personal information practices, please contact [email protected]
If you have a doubt as regards to which organization you should apply for a TUE, or as to the recognition process, or any other question about TUEs, please contact: [email protected]
Other useful links
WADA International Standard for Therapeutic Use Exemptions (ISTUE)
WADA Q&A on Therapeutic Use Exemptions
WADA Checklists for TUE Applications
WADA Guidelines for the 2021 International Standard for Therapeutic Use Exemptions (ISTUE)
WADA Anti-Doping Education and Learning (ADEL)
WADA International Standard for the Protection of Privacy and Personal Information (ISPPPI) | (wada-ama.org)