This paper addresses the enhanced removal of pharmaceutical compounds (PhCs), a family of contaminants of emerging concern, and effluent organic matter (EfOM) in water reclamation by powdered activated carbon/coagulation/ceramic microfiltration (PAC/cMF). Four chemically diverse PhCs are targeted: ibuprofen (IBP), carbamazepine (CBZ), sulfamethoxazole (SMX) and atenolol (ATN). Pilot assays (100 L/(m2 h), 10 mg Fe/L) run with PhC-spiked sand-filtered secondary effluent and 15 mg/L PAC dosed in-line or to a 15-min contactor. They showed no PAC-driven membrane fouling and +15 to +18% added removal with PAC contactor, reaching significant removals of CBZ and ATN (59%–60%), SMX (50%), colour (48%), A254 (35%) and dissolved organic carbon (DOC, 28%). Earlier long-term demo tests with the same pilot proved PAC/cMF to consistently produce highly clarified (monthly median < 0.1 NTU) and bacteria-free water, regardless of the severe variations in its intake. A detailed cost analysis points to total production costs of 0.21 €/m3 for 50,000 m3/day and 20 years membrane lifespan, mainly associated to equipment/membranes replacement, capital and reagents.