A photocathode-microbial electrochemical coupling system (PC-MFC) using black phosphorus-doped titanium dioxide nanobelt (BP/TB) as a photocatalyst is constructed for the degradation of hydroxychloroquine (HCQ, used to treat COVID-19). The degradation efficiency of HCQ (100 mg/L) in coupling system is 73.7% within 8 h, higher than that of photocatalysis (69.5%), MFC (25.6%), and adsorption (9.6%). The photocathode coupling facilitates subsequent bioelectric treatment, resulting in complete degradation of HCQ (100 mg/L) within 96 h in PC-MFC, much higher than in MFC (51.1%). Illumination of PC-MFC significantly increases the cathodic abundance of Pseudomonadales ord. (from 1.83% to 66.30%), accumulates biomass, improves the electrochemical behaviors of photocathode and bioanode, and finally increases the maximum power from 241 to 280 mW/m2. The electron transfer pathways depende on nicotinamide adenine dinucleotide dehydrogenase, succinate dehydrogenase and terminal oxidase. The coupled system enhances the dechlorination reduction of HCQ and reduces the biotoxicity of its degradation pathway. PC-MFC represents a new strategy for the treatment and energy recovery of refractory organic compounds in wastewater.