In the American Journal of Managed Care, David Grande and colleagues assess decision-making preferences of patients who face cost-related barriers to care or medication. Specifically, the authors evaluate which health care actors patients trust most to evaluate cost-efficacy tradeoffs and screen for cost barriers using administrative records. The authors conducted a survey of 1,400 patients (adults with a chronic disease seeking financial assistance) who rated a clinical vignette describing how a clinical decision was made in the context of a cost-efficacy tradeoff. Results show that patients most trust personal physicians to screen for cost barriers, with pharmacists, nurses and trained volunteers less preferred but still trusted. Results also reveal that patients value ‘patient-directed’ decision-making about cost barriers rather than unilateral decision-making by physicians. The study highlights the significance of shared patient-physician decision-making regarding cost-efficacy tradeoffs, especially as more patients enroll in plans with higher cost-sharing arrangements.