WASHINGTON >> President Donald Trump has made big promises to reduce prescription drug costs, but his administration is moving toward relatively modest steps such as letting Medicare patients share in manufacturer rebates.

The White House is spelling out its plan before next week’s budget release.

It focuses mainly on Medicare and Medicaid changes, along with ideas for speeding drug approvals and fostering competition.

Some ideas would represent tangible change, and they have a realistic chance of being enacted.

But the plan doesn’t include major changes such as letting Medicare negotiate prices or allowing consumers to import prescriptions from abroad.

Skeptics say the overall approach is underwhelming. Trump risks being seen as an ally of the powerful pharmaceutical industry, not its disrupter.

More details are expected when the president’s budget is released Monday.