Freshwater is one of the most vital aspects of human existence, and the need for this essential resource is soaring which is attributed to the exponentially growing world population. Water quality, on the other side, has now become a serious issue because of widespread degradation caused by excessive wastewater generation, ineffective treatment prior to discharge to water bodies, and the emergence of new contaminants classified as toxins of public health concerns. The pharmaceutical contaminants are emerging contaminants of the present time. Due to its nondegradable behavior, it persists in the ecosystem and has an adverse effect even in trace amounts. The detection of these pharmaceutical contaminants in water bodies and wastewater has received considerable attention. The major contributor of pharmaceutical contaminants in wastewater is from households, hospitals, and pharmaceutical manufacturing industries. Biological treatment methods are utilized for the treatment of pharmaceutical wastewater (PWW), which resulted in the unsatisfactory removal of pharmaceutical contaminants. The main reason for concern in the biological wastewater treatment methods is the development of antibiotic resistance bacteria (ARB). The ineffective treated PWW, when discharged into water bodies can cause potential health risks in humans through accumulation, dispersion and proliferation into food web. Therefore, the studies have been conducted by combining physical treatment methods such as ozonation, photo-Fenton, advance oxidation processes, membrane, etc., to increase the effectiveness of PWW treatment. This chapter highlights the biological treatment methods and their inefficacies. The emphasis on hybrid treatment systems, their recent advancement, and performance evaluation was discussed in detail. © 2023 Elsevier Inc. All rights reserved.