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Three Things to Know about Therapeutic Use Exemptions (TUEs)

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It’s to be expected that cyclists may experience medical conditions over the course of their careers, which may require that they use a medication or receive medical treatment. If the substance or method prescribed to treat that medical condition is prohibited by the World Anti-Doping Agency (WADA), athletes can apply for a Therapeutic Use Exemption(TUE), and if granted, obtain permission to use a prohibited substance or method for a specified time period.

While slightly different, the USADA TUE Policy and UFC TUE Policy both outline the requirements for every step of the TUE process, including the application requirements, review process, and criteria for TUE approval.

An Independent Review Process

Under the USADA and UFC TUE Policies, TUE applications are reviewed by medical professionals who are members of an independent TUE Committee (TUEC), which must be comprised of medical experts with various areas of medical specialty, ranging from endocrinology to psychiatry. The USADA TUEC currently includes more than 20 medical professionals, many of whom are practicing physicians, work with cyclists, and publish research in their field of specialty.

Every TUE application is reviewed by at least two members of the TUEC, who conduct an individual and independent review of TUE applications assigned to the them. To ensure anonymity, each application is redacted to remove the cyclist’s name, personal contact information, and anything that would otherwise identify the athlete (e.g. patient ID number).

Having A Prescription is Not Enough

Every TUE application is judged on its medical merits and ability to satisfy specific criteria, so it’s important that cyclists have more than just a doctor’s prescription. In competitive sport, it’s essential that cyclists have documentation of a medical condition with a confirmed diagnosis, rationale for why non-prohibited alternatives are not medically appropriate, and a clear treatment plan to show that they require the prohibited substance or method. Betterment of generalized symptoms alone is not sufficient justification to obtain a TUE.

Under the TUE Policies, cyclists have the responsibility to demonstrate that they can satisfy four criteria for TUE approval before they are granted permission to use a prohibited substance or method. Based on the criteria, cyclists must show that the prohibited substance or method is needed to treat an acute or chronic condition, and that the treatment will only return them to their normal level of health, without offering any performance-enhancing benefits. Moreover, cyclists must be able to show that the prohibited substance or method is necessary because there are no other reasonable treatment alternatives, and that any previously used treatments were ineffective.

From the documentation provided, the USADA TUEC needs to be able to arrive at the same diagnosis and treatment plan as the cyclist’s physician without seeing the athlete. In general, a TUE is required in advance of using a medication, but specific rules vary based on the level of the cyclist, the specific medication, and the circumstances of use. To be safe, contact USADA for more information!

Top Reason for Returned Applications

One of the top reasons TUE applications are returned to cyclists before going to the TUEC is because the applications are incomplete, meaning they are either missing required signatures on the application form and/or lacking essential medical information.

Many times, rushing through the first few steps of the application process becomes problematic, so it’s important for cyclists and support personnel to select the appropriate application, fill it out completely and legibly, and supply the appropriate medical guidance document.

For more information on the TUE application process, visit the USADA TUE section or the UFC TUE section.

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