OBJECTIVE: The proportion of patients with epilepsy who have a non-intravenous rescue benzodiazepine (non-IV-rBZD) available for seizure emergencies is unknown. This study aims to describe prescription patterns from 2006 to 2022, factors associated with prescription, and the impact of recently introduced intranasal benzodiazepines on prescription and cost. METHODS: Retrospective analysis of the MarketScan Database, a claims database of privately insured patients in the United States. RESULTS: Among 213 384 patients (53% female, median (p SIGNIFICANCE: The vast majority of patients with epilepsy have not filled a prescription for non-IV-rBZDs. Seizure emergency readiness can be markedly improved, especially among adults. The cost of non-IV-rBZDs has increased with intranasal rescue medications.