Pharmacy remuneration commonly attaches financial recognition to discrete activities or completed encounters, even when medication-related need persists beyond the point at which the billable event ends. This creates a potential mismatch between the unit of payment and the longitudinal work required to make care effective. This conceptual and policy article develops a Continuity-Oriented Remuneration Framework for examining that mismatch. The framework separates five questions that payment systems frequently collapse: what work was initiated, what follow-up remains necessary, whether the underlying need was resolved, whether coordination with other actors occurred, and whether structural conditions alter the resources required to achieve continuity. Evidence from pharmacy remuneration, value-based payment, unfunded professional services, transitions of care, service sustainability, spatial pharmacy access, and equity-adjusted payment indicates that professional authority, service delivery, payment recognition, and patient benefit are not interchangeable. A completed encounter can therefore be an administratively valid endpoint without being a clinically meaningful endpoint. The framework does not prescribe a universal payment formula or presume that fee-for-service, capitation, performance payment, or continuity-sensitive payment is inherently superior. Instead, it proposes that remuneration be evaluated according to which forms of clinically relevant work it makes economically visible, which incentives it creates, which work remains unrecognized, and which distortions it may introduce. Continuity-sensitive design is most defensible when payment components remain attributable, operationally feasible, resistant to unnecessary activity, and responsive to unequal resource requirements without using demographic identity as a proxy for individual need. The central policy implication is that remuneration should be judged by the work and consequences it recognizes across time, not solely by the completion of a reimbursable encounter.
