So far, much of the heated discussion about Angelina Jolie’s brave Op-Ed in the New York Times today has focused on her decision to undergo a double mastectomy after learning she carried the BRCA1 gene. As Salon noted here, that’s not the only option. But for those who do want to consider following Jolie’s path, there are structural barriers to even gaining the information to make those choices, something she mentions but doesn’t explain. It’s because one company, Myriad Genetics, owns the patent to the two genes that indicate an increased risk of breast or ovarian cancer. You read that right: The genes themselves, not the procedure to test for them. And the Supreme Court will decide in a matter of weeks whether that should continue.

Jolie wrote, “It has got to be a priority to ensure that more women can access gene testing and lifesaving preventive treatment, whatever their means and background, wherever they live. The cost of testing for BRCA1 and BRCA2, at more than $3,000 in the United States, remains an obstacle for many women.” According to the ACLU, which brought the lawsuit heard recently by the Supreme Court, Myriad actually recently raised the price to over $4,000, despite the fact that “genetic testing technologies have advanced to the point where all 23,000 human genes can be sequenced for $1000.” The test is often covered by insurance, but policies vary, and of course, not everyone is insured.

Myriad’s monopoly over BRCA1 and BRCA2 not only means showing that it can charge whatever it wants for the test; it also means that further research on the genes is restricted, and that women who take the test and get an ambiguous result can’t get a second opinion, only take the test again. An ambiguous result can mean the difference between removing breasts or ovaries or leaving them intact.