Choice and sound quality. You don’t "need" a preamp.
A good example of having separates is an electrostatic speaker. You love the sound of tubes, but the tube amps tend to be poor performers (queue the chorus of A’goners who will "not always.." this post) so you mix a tube pre wiht solid state amp.
Also, simply power. Having separates allows you to up/downgrade your power size and try different amps (D, A, A/B) without changing the pre.
In a sense, it's similar to having a separate DAC from your preamp. Having these separate lets you change your DAC while keeping everything else.