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How to get the creamy sauce (cremina)?
The beautiful creamy consistency of the sauce (called a cremina in Italian), is NOT achieved with cream, but by the combination of pecorino romano and the starchy pasta water. Letting the pasta finish cooking in the pan is also crucial. When the pasta is cooking in the pan, the pasta releases a lot of starch, contributing to the creaminess of the sauce.

Boil the pasta for half the amount of time that the package indicates (eg. if it says, 10 minutes on the package, boil it for 5 minutes). Add the pasta to the pan (it will finish cooking in the pan). Over medium heat, let the pasta finish cooking in the pan. Move it around with tongs, and by shaking the pan when it is cooking. Add pasta water as needed. The point is to get the starch to release into the pan. You want there to be a little bit of starchy liquid left in the pan. This is what helps form the cream.

While the pasta is cooking in the pan, add a small amount of pasta water to the grated pecorino. With a fork, mix the pasta water in until the mixture forms a paste. Set it aside When the pasta is al dente, remove the pasta from the heat. Wait 30 seconds, and add the pecorino mixture to the pan, and stir quickly with tongs. A beautiful creamy consistency should form between the pecorino and the starchy liquid in the pan. Plate, and spoon the creamy sauce on top. Add more fresh pepper if desired. Enjoy your cacio e pepe!