Updated June 2025

The NCAA recognizes that some banned substances are used for legitimate medical purposes. Accordingly, the NCAA allows exceptions to be made for those student-athletes with a demonstrated legitimate medical need to use certain banned substances. 

Consider non-banned medications.

Alternative non-banned medications for the treatment of various conditions may exist and should be considered before a medical exception is pursued.  If the student-athlete and the physician (in coordination with sports-medicine staff at the student-athlete's school, as applicable) agree that no appropriate alternative to the use of the banned substance is available, the decision to use a banned substance will be considered for medical exception review purposes.

When to request an exception for the use of NCAA banned substances.

Before a student-athlete participates (practice or competition):

Medical exceptions pre-approvals (MEPAs) are required for the following drug classes:

• Anabolic agents.
• Hormone and metabolic modulators.
• Peptide hormones, growth factors, related substances and mimetics.

Following a positive NCAA drug test:

Medical exceptions (MEs) are required for the following drug classes:

• Stimulants.
• Beta blockers or beta-2 agonists.
• Diuretics/masking agents.
• Narcotics.

Required documentation. 

Required Documentation for MEPAs

Use of medications in banned drug classes requiring preapproval must be granted by the NCAA before the student-athlete is allowed to participate (practice or competition) while taking these medications. 

The student-athlete’s school should collect and maintain documentation that supports use of the banned medication in the student-athlete’s medical record on campus. The documentation can be a letter or copies of medical notes from the prescribing physician that documents how the diagnosis was reached, and that the student-athlete has a medical history demonstrating the need for treatment with the banned medication. The letter should contain information as to the diagnosis (including appropriate verification of the diagnosis), medical history, and dosage information. The NCAA requires that schools submit pre-approval and continued use medical exception requests through the NCAA Requests/Self-Reports Online (RSRO) system. The submission should include all required medical documentation from the prescribing physician supporting the diagnosis and treatment. See the Banned Substances and Medical Exception Process FAQ for additional information.

The MEPA process is under continual reassessment and revision based on updates in medical standards, diagnostic tools, treatments, and national standards for sports. A prior approval does not mean that a MEPA will be automatically renewed. Rather, there is a careful and thorough review in each instance.

Required Documentation for MEs

If a student-athlete tests positive during an NCAA drug test for a substance for which the school desires a medical exception, normal reporting procedures for positive test results will be followed (See Section 8.0 of the NCAA Drug-Testing Manual). 

The student-athlete’s school should collect and maintain documentation that supports use of the banned medication in the student-athlete’s medical record on campus. The documentation can be a letter or copies of medical notes from the prescribing physician that documents how the diagnosis was reached, and that the student-athlete has a medical history demonstrating the need for treatment with the banned medication. The letter should contain information as to the diagnosis (including appropriate verification of the diagnosis), medical history, and dosage information.

The school should submit the NCAA Medical Exception Documentation Reporting Form to the NCAA-designated drug-testing agency as outlined in Section 8.0 of the NCAA Drug-Testing Manual along with medical documentation from the prescribing physician supporting the diagnosis (including appropriate verification of the diagnosis), medical history and treatment, and a prescription that would have been active as of the test date.

Communicating Decisions.

The NCAA will inform the director of athletics and/or their designee regarding the outcome of the medical exception request. It is the school’s responsibility to inform the student-athlete of the decision.

Appeals.

If the medical exception related to a positive NCAA drug test is not granted, the school may appeal this action according to Section 8.0 of the NCAA Drug-Testing Manual. Additional information on appeals can be found here. 

If you have questions about medical exception procedures for the NCAA Drug-Testing Program, please contact ssi@ncaa.org.