What happens after your Therapeutic Use Exemption (TUE) has been submitted?

Icon of clipboard with a tick on itThe following information applies to athletes or athlete support personnel who are submitting TUE applications to UKAD.

Athletes who have applied to their International Federation (IF) should contact their IF for more information on what happens after an application has been submitted.

Review of TUE Applications

UKAD undertakes an initial review of all applications to determine if

  1. the application needs to be processed, and
  2. if the application is complete.

An application will not be processed if the athlete is not included in the National TUE Pool, or if the substance is permitted in sport. All applicants will receive an email acknowledging receipt of the application and confirmation of the next steps typically within two working days.

If the application fails to meet the specified criteria as outlined in the how to apply for a TUE section, UKAD will request in writing any additional medical documents, which must be submitted before an application can be reviewed.

A complete TUE application is assessed by the UKAD TUE Committee which will either approve or reject the application in accordance with the below conditions for obtaining a TUE as defined in the WADA International Standards for Therapeutic Use Exemptions (ISTUE). The TUE Committee may also request additional information before reaching a decision.

UKAD will notify athletes in writing of all decisions made by the TUE Committee (whether for the approval or rejection of a TUE application). Committee decisions are typically made within seven days of receipt of a complete application.

Please note: All personal information relating to the athlete is redacted by UKAD prior to sending the application to the TUE Committee for review.

Conditions for obtaining a TUE

An athlete may be granted a TUE if (and only if) they can show, on the balance of probabilities that each of the following conditions are met:

  • The prohibited substance or prohibited method in question is needed to treat a diagnosed medical condition supported by relevant clinical evidence.

  • The therapeutic use of the prohibited substance or prohibited method will not 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 medical condition.

  • The prohibited substance or prohibited 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 prohibited method is not a consequence, 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.

Approval Process

When an application is approved, the athlete will be sent a TUE certificate with a specified effective date and duration of approval. The certificate outlines the exact medication, dose, frequency, and route of administration for which the exemption has been provided. It is the responsibility of the athlete to notify UKAD if there is a change to the approved treatment plan during the exemption period. The TUE that has been granted will become invalid without this notification. 

A TUE may be granted with a ‘condition of approval’. This means that the TUE will remain valid only if the athlete is able to submit further specified documents within a set time frame. It is the responsibility of the athlete to ensure that conditions of approval are upheld. ​

Upon expiry of this TUE, it is the athlete’s responsibility to submit a new application form and up to date supporting medical evidence to renew their TUE.

International Recognition

If an athlete is selected to compete at an international level, then the TUE granted by UKAD will not be valid for these purposes unless it is first recognised by the relevant IF or Major Event Organisation. The athlete can contact UKAD if they require any support through this recognition process.

Rejection Process

The TUE Committee may decide that the application does not fulfil the conditions for granting a TUE outlined within the ISTUE. In this instance, the application will be rejected, and the reasons will be provided in writing. To appeal the decision, a letter from the treating doctor outlining their grounds for appeal (and any further medical evidence they wish to provide) must be submitted to UKAD within ten working days of receipt of the decision. An appeal is reviewed by the TUE Appeal Panel which is formed of three different members of the TUE Committee who did not review the original application.

TUE Committee

The TUE Committee is a panel of independent doctors established by UKAD to consider athlete requests for a TUE. The Committee is comprised of doctors who are from different specialist fields and who have experience in the treatment of athletes. All applications are reviewed by three members of the Committee, who are selected to form a review panel based on the medical condition in question. A TUE review panel must be unanimous in its decision for an application to be approved. In order to ensure impartiality of decisions, all members of the TUEC must declare that they do not have any conflicts of interest and sign a confidentiality declaration.

TUE Fairness Review Panel

In response to the addition of Article 4.3 to the 2021 ISTUE, UKAD has established a TUE Fairness Review Panel to consider athlete requests for a ‘fairness’ TUE (that is, a retroactive application which does not meet the conditions set out in Article 4.1 or 4.2 of the ISTUE). The Panel is comprised of two staff representatives from UKAD (non-voting) and three external experts in medicine, ethics, and law – all of whom have experience in advising on anti-doping policy or regulatory matters within sport. All three external experts must be unanimous in their decision for a fairness TUE to be granted.

Please note: A fairness TUE will be reserved for exceptional circumstances where it would be manifestly unfair (when considering the purposes of the Code) not to grant a retroactive TUE. The granting of a fairness TUE for International- and National-level athletes will only be possible with prior approval from WADA.