The manufacturing of pharmaceuticals also produces wastes, mainly wastewaters (WWs). These WWs must be responsibly managed. Sometimes, the organic contents of these WWs are not easily removable in standard WW treatment, hence technical options must be investigated to pretreat such WWs in order to remove or destroy the recalcitrant compounds, mostly the active pharmaceutical ingredients themselves. This contribution from a pharmaceuticals company describes WW assessment and management principles, the search for pretreatment options and several case studies on WW (pre)treatment at some pharma production sites of the Roche Group.