Hi ArgleBargle- I have never been on effexor, so I cannot give you specifics as to the cost of the drug. However, you can search the internet and probably find out what the average cost of it is in the US. There are also prescription assistance programs where you can receive free or low cost medications if you have trouble affording it. The pharmaceutical companies, as well as most doctors have the information on how to apply for those programs. In the United States, the type of health insurance you have would determine whether or not you need a referral to see a psychiatrist. Usually, if you have PPO insurance, you don't need a referral, but for HMO's you normally do. If you have no insurance, you wouldn't need a referral either. I don't know if this is much help to you. If you have any other questions, feel free to ask. Good luck to you!