Do they need all that power? Sounds like it's more of an SoC with a modem than just a modem. Why then have another processor?
As far as I know, only u-blox is producing their own SoC (albeit for cat-m/nb-iot only) all the others are using existing solutions from Qualcomm and others.
This is only scratching the surface. I did not talk about certification which is another beast altogether.