Therapeutic Use Exemptions (TUEs) - Olympic Winter Games Milano Cortina 2026

Athletes may have illnesses or conditions that require them to take medications or undergo 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 authorisation 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 International TUE Committee (ITUEC).

First, check if the required medication or method you intend to take or use is prohibited as per the WADA Prohibited List.

For this, you may also use a ‘check your medication’ online like Global Drug Reference Online or consult your National Anti-Doping Organisation (NADO).

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 whatever substance/method you are prescribed. If the substance/method is prohibited, discuss non-prohibited alternatives, if there are none, apply for a TUE. Remember athletes have the ultimate responsibility.

Contact ITA’s ITUEC if you have questions about the substance status ([email protected]).

You must apply for a TUE, as soon as the need to use the substance or method 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 section 4 (How to apply for a TUE?).

If you already have a TUE granted by your National Anti-Doping Organisation (NADO) or International Federation (IF), your TUE will be automatically recognised for the Period of the Games.

The IOC has delegated the management of TUEs to the ITA. All Milano Cortina 2026 participants are bound to the anti-doping rules and in particular its provisions related to TUEs. Very importantly, TUEs granted in the context of the Games, are only valid for the period of Games! Therefore TUEs for chronic conditions (like ADHD or diabetes) should be processed by your National Anti-Doping Organisations (NADOs) | World Anti-Doping Agency (wada-ama.org) or your International Federation in advance of the Games.

Before the opening of the Olympic Village

You should follow the usual process defined by your IF and NADO and submit new requests to your IF or NADO. The process is described here. Pre-existing TUEs will be automatically recognised for the Period of the Games.

After the opening of the Olympic Village

Please check chapter 4 below in order to know how to apply for a TUE during the Period of the Games.

FOR SECURITY REASONS, IT IS NOT ADVISED TO SEND APPLICATIONS BY EMAIL AND PHYSICAL FILES WILL NOT BE ACCEPTED IN THE OFFICE.

1 – Fill in the TUE Application Form, sign it and have it signed by your physician.

2 – Gather all the necessary supporting medical documentation related to your diagnosis (Checklists for TUE applications  and Medical Information to Support the Decisions of TUECs)

3A – Provide the form and the supporting documents using this online form.

OR

3B – Submit the form and the supporting documentation directly in ADAMS, if you are familiar with the process.

Should you require support and for any other situations you can book an online appointment to contact us in person.

Your TUE application must be submitted in a legible form using 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 costs incurred by the Athlete in making the TUE application and in supplementing it as required by the ITA’s ITUEC are the responsibility of the Athlete.
• 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 WADA’s Checklists for TUE applications for guidance and support during the TUE application process, 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.

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 the consequence of the prior use (without a TUE), of a substance or method which was prohibited at the time of use.

You may only apply retroactively for a TUE if:

• You required emergency or urgent treatment of a medical condition.
• There was insufficient time, opportunity or other exceptional circumstances that prevented you from submitting the TUE application or having it evaluated, before getting tested.
• As per the International Olympic Committee anti-doping rules you were not permitted or required to apply in advance for a TUE.
• You tested positive after using a substance Out-of-Competition that was only prohibited In-Competition (for example glucocorticoids).
• In rare and exceptional circumstances and notwithstanding any other provision in the ISTUE, you may apply for and be granted retroactive approval for a therapeutic use of a prohibited substance or method, if considering the purpose of the Code, it would be manifestly unfair not to grant a retroactive TUE. An Anti-Doping Organisation may grant an Athlete’s application for a retroactive TUE pursuant to this Article only with the prior approval of WADA (and WADA may in its absolute discretion agree with or reject the Anti-Doping Organisation’s decision).

Important note:

Using a prohibited substance or method without a TUE could result in an Anti-Doping Rule Violation.

In case an application for a retroactive TUE is necessary following sample collection, you are strongly advised to have a medical file prepared and ready to submit for evaluation.

ITA’s TUEC will automatically recognise your TUE for the Period of the Games without the need to review the relevant clinical information. If the TUE is correctly entered in ADAMS, there is no need to contact us. Nevertheless, should you require a confirmation, you can submit your request to the ITA in writing quoting your ADAMS TUE reference number.

You can download your TUE certificate directly from ADAMS.

The ITA’s ITUEC must render a decision as soon as possible, and usually within 21 days from the date of receipt of the complete TUE application, unless in exceptional circumstances. Nevertheless, during the Winter Olympic Games, treatment times are on average much shorter and all efforts will be made to provide a decision before a competition takes place. Applications arriving in an untimely manner or incomplete will receive a decision retroactively. It is the athlete’s and physician’s decision and responsibility to participate in an event without a prospective TUE (examples of untimely timing: a) any chronic injury or disease. b) ongoing pain for several days, but sending an application for prohibited treatment only on the eve of a competition)

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. 

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, if you require a materially different dosage, frequency, route or duration of administration, you should contact the organisation that granted your TUE, 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 ITA’s TUEC.

TUEs granted during the Winter Olympic Games Milano Cortina 2026, are only valid during the period of the Games. Should you have a chronic condition, or a treatment that is needed outside this period, you should contact your NADO or IF in order to prolong or renew your TUE.

A decision by the TUEC not to grant or not to recognise a TUE may be appealed by the Athlete exclusively to WADA. If the Athlete does not appeal (or WADA decides to uphold the refusal to grant/recognise the TUE and so rejects the appeal), the Athlete may not Use the Prohibited Substance or Prohibited Method in question in relation to the Winter Olympic Games Milano Cortina 2026, but any TUE granted by the Athlete’s National Anti-Doping Organisation or International Federation for that substance or method remains valid outside of the Winter Olympic Games Milano Cortina 2026.

The email address to enquire and/or send the request for review is: [email protected]

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 and in the TUE Application Form which can be found below. All members of the ITA’s 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, note that should you wish to revoke the right of the ITA’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 the TUEC and any other authorised 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.