Osmotic membrane bioreactors (OMBRs) are considered a suitable technology for treating wastewater containing tetracycline due to their high rejection and biodegradation efficiency. However, the impact of membrane fouling layer (i.e., chemical composition, microbial composition, and formation) on the filtration and biodegradation of tetracycline is still unclear. Herein, the effects of draw solute concentration and type on the formation of a membrane fouling layer for tetracycline filtration and its relationship with microbial activity were investigated. The results showed that over 99% of tetracycline was retained on the feed side by membrane rejection, and the fouling layer played an important role in tetracycline filtration. Specifically, membrane foulants resulted in a more hydrophilic membrane facilitating tetracycline filtration, while the tetracycline-degrading genera from the fouled membrane promoted tetracycline degradation. The structure equation model showed that tetracycline filtration dominated by electrostatic repulsion between tetracycline and the fouled membrane was more important than tetracycline degradation for tetracycline removal (path coefficient of 0.655 vs. 0.395). This study provided insights into the combined effect of membrane foulants and microorganisms on tetracycline removal.