WASHINGTON (AP) — The Trump administration is proposing changes to Medicare's prescription drug benefit that would affect people's costs over the next few years.

Officials say their goal is to lower costs and modernize Medicare, the government health insurance program that covers about 60 million seniors and disabled people. Some proposals could create winners and losers among seniors, insurers, middlemen and drugmakers.

The changes include more leeway for insurers to exclude a specific drug in Medicare's six "protected classes" of medications. Also, use of e-prescribing would grow.

And insurers could require "step therapy" for drugs given in a doctor's office, which means patients first have to try a lower-cost drug.

The administration also wants changes to Medicare rules so rebates from drugmakers get passed on to beneficiaries at the pharmacy.